Analysis of Immunization Financing Indicators of the WHO ... · Analysis of Immunization Financing Indicators of the WHO-UNICEF Joint Reporting Form (JRF), 2010-2014 Department of

Analysis of Immunization Financing Indicators of the

WHO-UNICEF Joint Reporting Form (JRF), 2010-2014

Department of Immunization Vaccines and Biologicals, World Health Organization

February 2016

1

Acknowledgements

This report has been prepared by Nikhil Mandalia (WHO consultant) and Claudio Politi (WHO/HQ),

with input and contributions from WHO immunization financing regional focal points Amos Petu

(AFRO), Alexis Satoulou-Maleyo (AFRO), Jorge Mendoza Aldana (WPRO), Irtaza Chaudhri (EMRO),

Niyazi Osman Cakmak (EURO), Pushpa Wijesinghe (SEARO), Claudia Patricia Castillo (PAHO/AMRO)

and Cara Bess Janusz (PAHO/AMRO).

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Contents Acknowledgements ................................................................................................................................. 1

List of Figures .......................................................................................................................................... 4

List of Tables ........................................................................................................................................... 5

List of abbreviations ................................................................................................................................ 6

Executive summary ................................................................................................................................. 7

Introduction ............................................................................................................................................ 8

Data and Methodology ......................................................................................................................... 10

Data Sources ..................................................................................................................................... 10

Identification and estimation of missing and inconsistent data ....................................................... 11

Country selection criteria .................................................................................................................. 13

Reporting Statistics ............................................................................................................................... 14

Global Analysis ...................................................................................................................................... 17

African Region ....................................................................................................................................... 25

Region of the Americas ......................................................................................................................... 32

Eastern Mediterranean Region ............................................................................................................. 39

European Region ................................................................................................................................... 46

South Eastern Asia Region .................................................................................................................... 52

Western Pacific Region ......................................................................................................................... 58

Gavi Countries ....................................................................................................................................... 65

Conclusion ............................................................................................................................................. 74

Annexes ................................................................................................................................................. 76

Annex 1 - African Region Tables ....................................................................................................... 76

AFR - Government expenditure on routine immunization (JRF 6540) ......................................... 76

AFR - Percentage of government expenditure on routine immunization funded by government

(JRF 6560) ...................................................................................................................................... 77

AFR - Government expenditure on vaccines (JRF 6510) ............................................................... 78

AFR – Total expenditure on vaccines (JRF 6520) .......................................................................... 80

AFR – Percentage of government expenditure on vaccines funded by government (JRF 6530) . 81

Annex 2 – Region of the Americas Tables ......................................................................................... 83

AMR – Government expenditure on routine immunization (JRF 6540) ....................................... 83

AMR – Percentage of government expenditure on routine immunization funded by government

(JRF 6560) ...................................................................................................................................... 84

AMR – Government expenditure on vaccines (JRF 6510) ............................................................. 85

AMR – Total expenditure on vaccines (JRF 6530) ......................................................................... 86

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AMR – Percentage of vaccine expenditures funded by government (JRF 6530) .......................... 87

Annex 3 – Eastern Mediterranean Region Tables ............................................................................. 88

EMR – Government expenditure on routine immunization (JRF 6540) ....................................... 88

EMR – Percentage of total routine immunization expenditures funded by government (JRF 6560)

...................................................................................................................................................... 88

EMR – Government expenditure on vaccines (JRF 6510) ............................................................. 89

EMR – Total expenditure on vaccines (JRF 6520) ......................................................................... 90

EMR – Percentage of total expenditure on vaccines funded by government .............................. 90

Annex 4 – European Region Tables ................................................................................................... 92

EUR – Government expenditure on routine immunization (JRF 6540) ........................................ 92

EUR – Percentage of total expenditure on routine immunization funded by government (JRF

6560) ............................................................................................................................................. 93

EUR – Government expenditure on vaccines (JRF 6510) .............................................................. 95

EUR – Total expenditure on vaccines (JRF 6520) .......................................................................... 96

EUR – Percentage of total expenditure on vaccines funded by government ............................... 98

Annex 5 – South Eastern Asia Region Tables .................................................................................. 100

SEAR – Government expenditure on routine immunization (JRF 6540) ..................................... 100

SEAR – Percentage of government expenditure on routine immunization funded by government

(JRF 6560) .................................................................................................................................... 100

SEAR – Government expenditure on vaccines (JRF 6510) .......................................................... 101

SEAR – Total expenditure on vaccines (JRF 6520) ...................................................................... 101

SEAR – Percentage of total expenditure on vaccines funded by government (JRF 6530) .......... 102

Annex 6 – Western Pacific Region Tables ....................................................................................... 103

WPR – Government expenditure on routine immunization (JRF 6540) ..................................... 103

WPR – Percentage of total expenditure on routine immunization funded by government (JRF

6560) ........................................................................................................................................... 104

WPR – Government expenditure on vaccines (JRF 6510) ........................................................... 105

WPR – Total expenditure on vaccines (JRF 6520) ....................................................................... 106

WPR – Percentage of total expenditure on vaccines funded by government (JRF 6530) .......... 107

Annex 7 – International exchange rate comparison – government expenditure on routine

immunization per live birth............................................................................................................. 108

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List of Figures

Figure 1 – Global – Government expenditure on RI ............................................................................. 19

Figure 2 – Global – Government expenditure on vaccines ................................................................... 22

Figure 3 – Global – Government expenditure on RI per live birth........................................................ 23

Figure 4 – Global – Total expenditure on vaccines per live birth ......................................................... 24

Figure 5 – African Region – Government expenditure on RI ................................................................ 26

Figure 6 – African Region - Government expenditure on vaccines ...................................................... 27

Figure 7 – African Region - Government expenditure on RI per live birth ........................................... 29

Figure 8 - African Region - Total expenditure on vaccines per live birth .............................................. 30

Figure 9 - Region of the Americas - Government expenditure on RI .................................................... 33

Figure 10 - Region of the Americas - Government expenditure on vaccines ....................................... 34

Figure 11 – Region of the Americas – Government expenditure on RI per live birth .......................... 36

Figure 12 – Region of the Americas – Total expenditure on vaccines per live birth ............................ 37

Figure 13 - Eastern Mediterranean Region - Government expenditure on RI...................................... 40

Figure 14 - Eastern Mediterranean Region - Government expenditure on vaccines ........................... 41

Figure 15 - Eastern Mediterranean Region - Government expenditure on RI per live birth ................ 43

Figure 16 - Eastern Mediterranean Region - Total expenditure on vaccines per live birth .................. 44

Figure 17 - European Region - Government expenditure on RI ........................................................... 47

Figure 18 - European Region - Government expenditure on vaccines ................................................. 48

Figure 19 - European region - Government expenditure on RI per live birth ....................................... 49

Figure 20 - European Region -Total expenditure on vaccines per live birth ......................................... 50

Figure 21 - South Eastern Asia Region - Government expenditure on RI ............................................. 53

Figure 22 - South Eastern Asia Region - Government expenditure on vaccines .................................. 54

Figure 23 - South Eastern Asia Region - Government expenditure on RI per live birth ....................... 55

Figure 24 - South Eastern Asia Region - Total expenditure on vaccines per live birth ......................... 56

Figure 25 - Western Pacific Region - Government expenditure on RI .................................................. 59

Figure 26 - Western Pacific Region - Government expenditure on vaccines ....................................... 60

Figure 27 - Western Pacific Region - Government expenditure on RI per live birth ............................ 62

Figure 28 - Western Pacific Region - Total expenditure on vaccines per live birth .............................. 63

Figure 29 - Gavi countries - Government expenditure on RI ................................................................ 66

Figure 30 - Gavi countries - Government expenditure on vaccines ..................................................... 67

Figure 31 - Gavi countries (Low income group) – Total expenditure on vaccines per live birth .......... 70

Figure 32 - Gavi countries (Phase 1 group) - Total expenditure on vaccines per live birth .................. 71

Figure 33 - Gavi countries (Phase 2 & 3 groups) - Total expenditure on vaccines per live birth .......... 72

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List of Tables

Table 1 - No. of countries selected in each analysis group ................................................................... 13

Table 2 – Reporting Statistics – All Quantitative Indicators .................................................................. 14

Table 3 – Reporting Statistics - Government expenditure on vaccines (JRF 6510) .............................. 15

Table 4 – Reporting Statistics - Total expenditure on vaccines (JRF 6520) ........................................... 15

Table 5 – Reporting Statistics - Percentage of total expenditure on vaccines funded by government (JRF 6530) .............................................................................................................................................. 15

Table 6 – Reporting Statistics - Government expenditure on RI (JRF 6540) ......................................... 15

Table 7 – Reporting Statistics - Total expenditure on RI (JRF 6550) ..................................................... 15

Table 8 – Reporting Statistics - Percentage of total expenditure on RI funded by government (JRF 6560) ..................................................................................................................................................... 16

Table 9 – Global – Line item in national budget for vaccines ............................................................... 17

Table 10 – Global – Government Expenditure on Routine Immunization ............................................ 18

Table 11 – Government expenditure on vaccines ................................................................................ 21

Table 12 – African Region – Indicators summary ................................................................................. 25

Table 13 – African Region - Government expenditure on RI per live birth .......................................... 28

Table 14 – African Region – Reporting Statistics .................................................................................. 31

Table 15 – Region of the Americas – Indicators summary ................................................................... 32

Table 16 – Region of the Americas - Government expenditure on RI per live birth............................. 35

Table 17– Region of the Americas – Reporting statistics ..................................................................... 37

Table 18– Eastern Mediterranean Region – Indicators summary ........................................................ 39

Table 19 – Eastern Mediterranean Region - Government expenditure on routine immunization per live birth ................................................................................................................................................ 42

Table 20 - Eastern Mediterranean Region - Reporting statistics .......................................................... 45

Table 21 – European Region – Indicators summary ............................................................................. 46

Table 22 – European Region - Government expenditure on routine immunization per live birth ...... 48

Table 23 – European Region – Reporting statistics .............................................................................. 51

Table 24 – South Eastern Asia Region – Indicators summary ............................................................... 52

Table 25 - South Eastern Asia Region - Government expenditure on RI per live birth ......................... 55

Table 26 - South Eastern Asia Region – Reporting statistics ................................................................. 57

Table 27 – Western Pacific Region – Indicators summary ................................................................... 58

Table 28 - Western Pacific Region - Government expenditure on RI per live birth .............................. 61

Table 29 - Western Pacific Region – Reporting statistics ...................................................................... 64

Table 30 – Gavi countries – Indicators summary .................................................................................. 65

Table 31 - Government expenditure on RI per live birth by Gavi (2016) co-financing groupings ........ 68

Table 32 – Gavi countries – Distribution of defaulting countries ......................................................... 69

Table 33 - Gavi Phase 2 & 3 countries - Government expenditure on vaccines per live birth (17 Countries with full time series) ............................................................................................................. 73

Table 34 - Gavi Phase 2 & 3 countries - Total expenditure on vaccines per live birth (17 Countries with full time series) ............................................................................................................................. 73

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List of abbreviations

AFR WHO African Region

AMR WHO Region of the Americas

cMYP comprehensive Multi-Year Plan

EIU The Economist Intelligence Unit

EMR WHO Eastern Mediterranean Region

EUR WHO European Region

HIC High Income Country

HPV Human Papillomavirus

JRF Joint Reporting Form

LIC Low Income Country

LMIC Lower Middle Income Country

PCV Pneumococcal Conjugate Vaccine

PWA Population Weighted Average

RI Routine Immunization

SEAR WHO South Eastern Asia Region

SHA System of Health Accounts

UMIC Upper Middle Income Country

WPR WHO Western Pacific Region

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Executive summary

This report presents an analysis of the financing indicators included in the WHO-UNICEF Joint

Reporting Form (JRF) for the period 2010-2014.

By 2014 the majority of WHO member states had reported a specific line item in the national budget

for the purchasing of vaccines. The number of countries reporting the inclusion of the line item in

2014 was 173 (89% of all member states), additionally 90% (66 countries) of all Gavi eligible

countries reported the line item, an increase from 2010.

As governments increased their expenditure on vaccines over the five year period, the aggregated

expenditure of 70 countries with a full time-series increased from 1,535 million US$ in 2010 to 1,893

million US$ in 2014. Donor funds for vaccines also increased over the same period, resulting in a

decrease to the percentage of total vaccine costs funded by government, from 73% to 70%.

The aggregated government expenditure on routine immunization was calculated over the same 70

countries, with results showing an increase from 1,759 million US$ in 2010, to 2,164 million in 2014.

As routine immunization costs also capture the costs of vaccines, the growth in donor support for

vaccine costs has had an effect on the percentage of total routine immunization costs funded by

government, illustrated by a decrease from 75% in 2010 to 73% in 2014.

The results of the global analysis indicate that financial commitment to immunization is increasing,

as represented by the increasing domestic funds that governments are allocating for the use of

immunization. Despite this, Gavi and other donor support is growing at such a rate that is drowning

out the proportion of government funding for immunization, reducing the overall financial

ownership of countries.

Analysis of individual regions displayed a large disparity that exists between relatively richer and

poorer regions; the countries in both the European region and the region of the Americas show

greater self-sufficiency in supporting their own immunization costs, with over 90% of total routine

immunization costs being funded by government on average over the five years period. However,

the African region is the most reliant on donor support having only funded 50% of total routine

immunization costs with domestic funds in 2010; but this has fallen to 40% in 2014.

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Introduction

In December 2010, global health leaders committed to making the following 10 years the Decade of

Vaccines (2011-2020), and in doing so initiated the Global Vaccine Action Plan (GVAP).

During the last 15 years significant progress has been made in expanding the reach of immunization

programmes globally. In spite of large increases to populations, immunization coverage remains on

an upward trend – playing a crucial part in reducing child mortality. Important too, are the increasing

number of vaccines being introduced into the immunization schedules of many countries, with

vaccines against Hepatitis B and Haemophilus type B integrated into routine operations in 176 and

192 countries respectively. Over a ten year period (2000-2010) it is estimated that the number of

deaths caused by traditional vaccine-preventable diseases (diphtheria, measles neonatal tetanus,

pertussis and poliomyelitis) fell by 0.9 million1.

In addition to the uptake of an increased amount of traditional vaccines, the past 15 years has also

witnessed the rise in availability of new and more sophisticated vaccines, such as pneumococcal

conjugate, Rotavirus and Human papillomavirus virus vaccine. Accelerated initiatives have been

implemented in order to shorten the historic time lag that has existed in the introduction of these

new vaccines between high and low income countries. However, with these new and underused

vaccines comes the burden of additional cost. These new vaccines come at a significantly higher cost

than traditional vaccines, and it is important to note that the burden is relatively greater for

countries that are classified as being Low and Lower-middle income, given the harsher fiscal

constraints they face in comparison to Upper-middle and High come countries.

As one of the most cost-effective public health interventions, countries are continually encouraged

to give priority to national immunization programs. The Global Vaccine Action Plan (GVAP) re-

iterates this, advocating country commitment and ownership of immunization as key tenets of

effective immunization systems. The GVAP provides the global framework for planning immunization

strategies over the period 2011 to 2020, and insists that the demonstration of commitment must

come through a combination of actions. This includes the setting of ambitious but attainable targets,

allocating sufficient domestic resources so that these targets can be reached, ensuring immunization

plans are well integrated into national health plans and additionally making sure that the

implementation of these plans are fully carried out.

Instrumental in providing support to low income countries is the Gavi Alliance, whose key goal is to

accelerate the uptake and use of underused and new vaccines. Gavi facilitate the introduction of

vaccines through co-financing arrangements with each country, reducing the financial encumbrance

on the country by taking the majority of the financial cost of the vaccines initially and then gradually

increasing the proportion paid by countries overtime.

1 Sources for estimates: measles and neonatal tetanus, in World Health Statistics 2012, Geneva, World Health

Organization, 2012; diphtheria and poliomyelitis, for 2000: http://www.who.int/entity/healthinfo/global_burden_disease/GHE_Deaths_2000_country.xls?ua=1 (accessed 10/02/2016)

http://www.who.int/entity/healthinfo/global_burden_disease/GHE_Deaths_2000_country.xls?ua=1

9

Given the rise in immunization costs and the increased external support that countries are now able

to receive, many questions are now being raised over the sustainability of these immunization

programmes. Accordingly, the importance of government ownership over immunization planning,

budgeting and financing has been pushed to the foreground. Unfortunately, the abundance of donor

support, whilst no doubt beneficial, may inadvertently serve to undermine the long-term

sustainability of immunization services. The goal of self-sufficiency is apparent for countries;

however a misalignment of incentives could occur between the donor and country in the short-term

leading to governments treating the external aid as a substitution for, rather than an addition to,

government immunization spending. Additionally, if there is a smaller share of domestic resources

being mobilized relative to a large share of external resources, incentives for the governments to

address the inefficiencies or bottlenecks in the delivery of immunization services is somewhat

diminished. This shirking of responsibility may stunt the development of national capacity and will

likely hinder progress towards the building of proper governance, undermining the long-term

sustainability of the immunization programme.

Another key concern of low ownership is its potential distortive effect on the budgeting and

planning processes. As external funding often comes in the form of direct support for a

vaccine/project, it becomes difficult for governments to discern the exact flow of resources coming

into the country and with this comes uncertainty over what the outlay for expenditure on

immunization should be. This budgetary uncertainty can have a detrimental effect in the way of

producing discontinuous and unproductive delivery of immunization services. For example, if district

managers are unaware of their own budget allocations they then face an impossible task in their

processes of planning and implementation.

Given the concerns over long-term sustainability, ownership and commitment, Gavi and other

partners have implemented policies targeted at addressing these issues. Particularly important is the

Gavi co-financing policy for the introduction of new and underused vaccines, which looks to address

the issue of financial sustainability by gradually transferring financial ownership of vaccine costs over

a period of time according to the growth in income of the country.

Since 1998, the WHO-UNICEF Joint Reporting Form (JRF) mechanism has been collecting data on

immunization financing as part of a set of immunization indicators designed to measure

immunization coverage and system performance in WHO member states.

The financing indicators included in the JRF aim to capture the expenditure on routine immunization,

the expenditure on vaccines, the percentage financed by government and the existence of a national

budget line for the purchase of vaccines.

With the current focus on the sustainability of immunization programmes, the JRF financing

indicators analysis provides a good opportunity explore the global, regional and country trends in

financial ownership of, and commitment to immunization. This report presents an analysis of the

financing indicators for the period 2010-2014.

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Data and Methodology

Data Sources

The main source of data is the WHO-UNICEF Joint Reporting Forms (JRF) reported by countries for

the period 2010-2014. JRF data is reported annually by countries, with this data then uploaded to

the JRF database which is available on the WHO Immunization surveillance, assessment and

monitoring website.2

The JRF includes one qualitative indicator and six immunization expenditure indicators:

The qualitative indicator is expressed in the form of a “Yes/No” answer:

o Availability of a specific line item in the national budget for the purchase of vaccines

used in routine immunization (JRF 6500).

Four indicators are expressed in absolute values (US$ or local currency):

o Government expenditure on vaccines used for routine immunization (JRF 6510).

o Total expenditure (from all sources) on vaccines used for routine immunization (JRF

6520).

o Government expenditure on routine immunization, including vaccines (JRF 6540).

o Total expenditure (from all sources) on routine immunization, including vaccines

(JRF 6550).

Two indicators are expressed in percentages (%):

o Percentage of vaccine expenditure used for routine immunization financed by

government (JRF 6530).

o Percentage of routine immunization expenditure financed by government (JRF 6560).

Data reported in local currency amounts has been converted to US dollars, using the annual average

exchange rate available on the Economic Intelligence Unit (EIU)3 database.

Three additional sources of data have been used in the preparation of this analysis: countries’

comprehensive Multi-Year Plans (cMYPs)4, multi-country immunization costing and financing studies

(EPIC)5 co-ordinated by the Bill and Melinda Gates Foundation, and the UN Population Division’s

database6. Both the cMYPs and EPIC studies were used to cross-check and in some cases supplement

countries’ reported JRF data (see section: Identification and estimation of missing and inconsistent

data). From the UN population data, information regarding the number of live births for each

country was extracted to allow for the financing indicators to be expressed in terms of per live birth

per year and additionally to provide data for population weighted average estimates. In addition,

Gross National Income (GNI) per capita data extracted from the World Bank World Development

2 http://apps.who.int/immunization_monitoring/globalsummary/indicators

3 https://eiu.bvdep.com/version-2015612/cgi/template.dll?product=101&user=ipaddress

4 http://www.who.int/immunization/programmes_systems/financing/countries/en/

5 http://www.immunizationcosting.org/

6 http://www.un.org/en/development/desa/population/publications/development/population-development-

database-2014.shtml

http://apps.who.int/immunization_monitoring/globalsummary/indicators

https://eiu.bvdep.com/version-2015612/cgi/template.dll?product=101&user=ipaddress

http://www.who.int/immunization/programmes_systems/financing/countries/en/

http://www.immunizationcosting.org/

http://www.un.org/en/development/desa/population/publications/development/population-development-database-2014.shtml

http://www.un.org/en/development/desa/population/publications/development/population-development-database-2014.shtml

11

Indicators7 has been used for the aggregation of countries by Income group and Gavi co-financing

group.

Identification and estimation of missing and inconsistent data

Interest in the JRF financing indicators has increased over time alongside the increased focus on

financial sustainability of immunization. The utilization of the indicators has also improved with

countries paying closer attention to the emerging trends, as are the global community and the

World Health Assembly.

In spite of this, the completeness and accuracy of immunization and vaccine expenditure data for

the full range of countries is currently lacking; errors, inconsistencies and missing data frequently

identified when compiling and analysing the JRF data.

When the JRF data is reported, various techniques are used to assess its consistency and accuracy.

The following five rules of internal validity were used to assess the consistency of the country

reported data:

1. Total expenditure (from all sources) on routine immunization must be higher than total

expenditure (from all sources) on vaccines.

2. Total expenditure (from all sources) on routine immunization must higher than or equal to

government expenditure on routine immunization.

3. Total expenditure (from all sources) on vaccines must be higher than or equal to

government expenditure on vaccines.

4. Government expenditure on routine immunization must be higher than the government

expenditures on vaccines.

5. The reported percentage of government funding and the calculated percentage of

government funding (obtained by dividing the reported amount of government funding by

the total expenditure for both routine immunization and vaccine expenditures) must be

equal.

Reported expenditure figures were compared against Gavi disbursement and co-financing amounts

where data was available. The time-series of each of the indicators were thoroughly examined to

help recognise extremely divergent values reported from one year to the other, alongside mistakes

such as typing and currency reporting errors. These potential inconsistencies were recorded and

shared with member states through WHO regional offices as a mechanism of providing active

feedback, allowing for the member states to revise their JRF submissions. Due to this, data used in

previous JRF financing indicator analyses has been subject to change.

Inconsistent data points were either dropped or replaced with WHO estimates. In addition to

replacing data, estimates were used in place of missing data to help create a full time-series of

observations for countries. Of course, the use of estimates were used sparingly so as not to augment

the dataset too heavily. A number of methods different were used to develop the estimations:

7 http://data.worldbank.org/data-catalog/world-development-indicators

12

Estimations for the qualitative budget line item indicator were assessed based on the trends

observed over the time-series. If for a given year, a country had not reported data but had

done so for the other years, uniformly reporting “Yes” or “No”, and then the observed trend

was taken as sufficient reason for imputing missing values so as to continue the trend.

Estimations for the quantitative expenditure indicators were calculated as follows:

o If a country was missing one of the three expenditure figures (for either vaccines or

routine immunization) but reported the other two (i.e. missing government

expenditure, but reported total expenditure and percentage of total expenditure

funded by government) then the missing indicator would be calculated accordingly.

o By taking the average of available data i.e. if a country failed to report an indicator

for a certain year but managed to report for the previous and subsequent year, then

the average of those two data points may have been used to fill the missing

observation.

o By assuming the continuation of a previous long running time series trend, using

simple linear stepwise extrapolation i.e. if the subsequent 3 years of data was

available, then it would be used to calculate the 4th and missing year of data.

o By using data extracted from a country’s comprehensive Multi-Year Plan (cMYP)

Costing and Financing tool, if the missing data was that of the country’s baseline

expenditure year.

o By using data extracted from the BMGF EPIC studies.

The country response rates, number of inconsistencies and the number of estimations calculated

have been summarised and are elaborated on in the reporting statistics section.

13

Country selection criteria

To allow for consistent analysis over the time period, across countries in each region, and across the

regions themselves countries were only selected for analysis if they reported a full 5 year time series

(2010 to 2014) for each of the following three indicators:

Government expenditure on vaccines used in routine immunization.

Total expenditure (from all sources) on vaccines used in routine immunization.

Government expenditure on routine immunization, including vaccines.

By ensuring consistency amongst the countries in these 3 indicators, the analysis was able to make

use of the relationship that exists between the indicators in order to examine the expenditure trends

in absolute amounts as well as the manner in which the trends move in proportion to one and other.

The full time-series was also necessary so that population weighted averages could be calculated

using a consistent population over time. If a country were to fail to report for a given year but still

have its population weight taken into account, this would have created biased and deflated averages.

The following table presents the number of countries included in each of the regional analyses:

Table 1 - No. of countries selected in each analysis group

Analysis Group No. of countries

Global 70

African Region (AFR) 18

Region of the Americas (AMR) 24

Eastern Mediterranean Region (EMR) 7

European Region (EUR) 7

South Eastern Asia Region (SEAR) 7

Western Pacific Region (WPR) 7

Gavi countries 38

Gavi Low Income Co-financing Group 14

Gavi Phase 1 Co-financing Group 11

Gavi Phase 2&3 Co-financing Group 13

For certain parts of the analysis the country selection criteria is widened to include all available

observations regardless of full time-series; this is most notably the case when calculating the simple

average in percentage of total expenditure of both RI and vaccine indicators across entire regions.

14

Reporting Statistics

The following provides a brief analysis of the trends in reporting for each of the JRF financing

indicators. As stated earlier, the quality of country reporting for the JRF financing indicators has long

been an issue, with countries facing many challenges when looking to quantify immunization

expenditure data. In response to this, initiatives have been undertaken as a comprehensive effort to

strengthen local and regional capacities, active feedback, and use of immunization financing data;

these initiatives include the preparation and dissemination of a JRF guidance note by the Gavi

Immunization and Financing Sustainability (IF&S) Task Team. The guidance note provides countries

with comprehensive definitions for each indicator as well as assistance on how to collect, estimate,

validate and report the correct data.

Additionally, a JRF peer review workshop was organised in early April of 2014 for countries in East

and Southern Africa. This allowed for the sharing of best practice amongst country participants,

through the critical analysis 2013 JRF data, and additionally gave countries a platform to present

feedback to WHO regarding the clarity and general understanding of variables in the JRF template.

Particularly important was the fact that the workshop aided the development of capacity at county-

level, contributing to the improvement of reporting for future years.

The tables below summarise the reporting statistics for each of the JRF financing indicators over the

period 2010 to 2014.

Table 2 – Reporting Statistics – All Quantitative Indicators

All six indicators

2010 2011 2012 2013 2014

Missing 430 457 452 440 411

Inconsistencies 98 86 57 70 60

Estimates 231 228 198 167 99

Table 2 shows the aggregated reporting statistics for all countries, across all indicators between the

years 2010 and 2014. The number of missing indicators decreased over the five years, from 430

missing in 2010 to 411 in 2014. In spite of this decrease, there does not seem to be a discernible

trend in the reporting of statistics, with the amount of missing indicators varying greatly between

years.

Encouraging signs can be seen in the trend for number of inconsistencies identified, which have

decreased over time, from 98 inconsistencies in 2010 to 60 in 2014. In addition to this, the number

of estimates being calculated can be seen to be falling as well from 231 in 2010 to 99 in 2014. A fairly

significant improvement can be seen across all reporting statistics in the year 2014, which may be

attributable to efforts made by countries, as well as supportive activities by WHO and partner

organizations.

15

Table 3 – Reporting Statistics - Government expenditure on vaccines (JRF 6510)

Government Expenditure on Vaccines (JRF 6510)

2010 2011 2012 2013 2014

Missing 46 56 56 49 52


Estimates 19 27 19 14 9

Table 4 – Reporting Statistics - Total expenditure on vaccines (JRF 6520)

Total Expenditure on Vaccines (from all sources) (JRF 6520)

2010 2011 2012 2013 2014

Missing 73 77 67 62 59


Estimates 40 41 29 24 12

Table 5 – Reporting Statistics - Percentage of total expenditure on vaccines funded by government (JRF 6530)

Percentage of Total Expenditure on Vaccines Funded by Government (JRF 6530)

2010 2011 2012 2013 2014

Missing 59 59 61 60 60


Estimates 41 40 37 34 33

Table 6 – Reporting Statistics - Government expenditure on RI (JRF 6540)

Government Expenditure on Routine Immunization (JRF 6540)

2010 2011 2012 2013 2014

Missing 86 95 93 96 84


Estimates 34 32 33 27 11

Table 7 – Reporting Statistics - Total expenditure on RI (JRF 6550)

Total Expenditure on Routine Immunization (from all sources) (JRF 6550)

2010 2011 2012 2013 2014

Missing 97 100 98 99 85


Estimates 40 38 30 26 9

16

Table 8 – Reporting Statistics - Percentage of total expenditure on RI funded by government (JRF 6560)

Percentage of Total Expenditure on Routine Immunization Funded by Government (JRF 6560)

2010 2011 2012 2013 2014

Missing 69 70 77 74 71


Estimates 57 50 50 42 25

There is a considerable disparity in reporting between the vaccine expenditure indicators and the

indicators pertaining to routine immunization, this is especially evident when looking at the

differences between Table 3 which looks at government expenditure on vaccines and Table 6 on

government expenditure on RI. The number of missing indicators for vaccine expenditures is almost

half that of RI expenditures. In addition, if the number of missing is compared between all indicators

it is apparent that total expenditure on RI (JRF 6550) suffers as the indicator with the worst reporting

rate over the five year period.

The difference in reporting rate between the vaccine and the RI indicators highlights the challenge

that many countries have faced in quantifying expenditures for routine immunization. Vaccine

expenditure data is known to be relatively easier for countries to gather, given that vaccines are

usually procured through central government in a pooled way for all districts in a country. Whereas a

lack of sub-national resource tracking can hinder efforts to identify and record routine costs. In

addition to this, the fact that immunization is integrated within a number of different service

delivery platforms can make it difficult to disaggregate what may be considered shared costs and

immunization specific costs. The task is made much more difficult when looking beyond government

expenditures on RI and looking to include external funding, which may come in the form of direct

support for a project rather than as a supplemental amount to an existing budget.

17

Global Analysis

194 countries by income classification and Gavi eligibility:

Income Classification Group

Low Income Lower Middle

Income Upper Middle

Income High Income N/A Total

Total no. of countries 34 48 54 55 3 194

Of which are Gavi eligible 34 36 3 0 0 73

Line item in national budget for the purchasing of vaccines used in routine immunization

Table 9 – Global – Line item in national budget for vaccines

Indicators (Global) 2010 2011 2012 2013 2014

Line item in national budget for vaccines (No. of countries)

-Global (194) 170 170 173 174 173

-AFR (46) 44 44 44 46 44

-AMR (35) 31 30 31 30 31

-EMR (22) 19 19 18 19 19

-EUR (53) 42 42 44 43 43

-SEAR (11) 10 10 11 11 11

-WPR (27) 24 25 25 25 25

-Gavi (73) 65 66 66 69 66

By 2014 173 countries had reported a specific line item in the national budget for the purchasing of

vaccines representing 89% of all member states. The number of countries reporting the line item

increased between the years 2010 to 2014, by 3. However, the increases did not occur in a

consistent manner with the number of countries reporting the line item increasing over the years

2010 to 2013, from 170 to 174 but declining in the subsequent year (2014) to 173.

It is encouraging that the numbers of countries reporting the inclusion of a line item in the national

budget are increasing as this indicates growing government commitment to financing vaccines.

However, these results should be interpreted with caution as the inclusion of the budget line item

does not always guarantee government funding for vaccines. In addition to this, the level of

consistency in reporting varies across each region, with large amounts of variation observable in the

European region and the region of the Americas. However, it is unclear as to whether this is a true

reflection of the realities for the countries in these regions or whether it is due to erroneous

reporting.

18

Government Expenditures on Routine Immunization

Table 10 – Global – Government Expenditure on Routine Immunization

Indicators 2010 2011 2012 2013 2014

% of total RI funded by government in the region (average)

-Global (194) 75% 74% 74% 73% 73%

-AFR (46) 50% 48% 46% 40% 40%

-AMR (35) 95% 93% 94% 95% 95%

-EMR (22) 73% 70% 75% 73% 74%

-EUR (53) 92% 91% 91% 89% 92%

-SEAR (11) 69% 63% 62% 72% 63%

-WPR (27) 59% 65% 66% 71% 71%

-Gavi (73) 46% 42% 43% 42% 42%

% of total RI funded by government in selected countries (average)

-Global (70 countries) 68% 64% 66% 68% 67%

Aggregated expenditure on RI in selected countries (Millions US$)

-Global (70 countries) 1,759 1,843 1,821 1,816 2,164

-AFR (18 countries) 52 49 50 52 58

-AMR (24 countries) 1,076 1,128 1,070 1,076 1,419

-EMR (7 countries) 45 48 66 70 85

-EUR (7 countries) 147 159 149 144 136

-SEAR (7 countries) 125 128 146 147 123

-WPR (7 countries) 314 331 340 328 345

-Gavi (38 countries) 236 237 242 245 259

Government expenditure on RI Per Live Birth in selected countries (Population Weighted Average US$)

-Global (70 countries) 36.2 37.5 36.4 35.6 41.9

-AFR (18 countries) 5.7 5.3 5.3 5.3 5.8

-AMR (24 countries) 149.5 156.2 146.2 144.6 187.9

-EMR (7 countries) 12.1 12.6 17.2 17.9 21.7

-EUR (7 countries) 210.0 220.8 198.9 186.4 173.1

-SEAR (7 countries) 12.9 13.1 14.5 14.3 11.7

-WPR (7 countries) 17.3 18.1 18.3 17.4 18.0

-Gavi (38 countries) 10.1 10.0 10.0 9.9 10.4

19

Figure 1 – Global – Government expenditure on RI

The average percentage of total expenditure on routine immunization funded by government, for all

countries presented an overall decline over the period 2010 to 2014, from 75% to 73%. The trend is

relatively stable, with the magnitude of change across the years relatively low given the trends

reported in some regions such as the South-Eastern region, which reported wide variation from year

to year.

Throughout the five year period, the African region consistently displayed the lowest proportion of

government funding for RI, amongst all of the regions. 81% of the countries in the African region (38

countries) are classified as either Low or Lower middle income countries, which is the highest

proportion of all regions, and additionally 79% of the countries in the region (37 countries) are Gavi

eligible leading to the notion that these countries will be much more reliant on donor support than

other regions.

The region which had the highest proportion of government funding RI throughout the time series

was the region of the Americas, which reported a relatively stable percentage of approximately 95%

from year to year. 28 of the 36 countries in this region (78%) are classified as High or Upper middle

income which helps to explain the relatively low reliance on external funding for immunization. The

region which had the second highest proportion of government funding RI throughout the period

was Europe; which is actually the region with the highest proportion of High and Upper middle

income countries.

68% 64%

66% 68% 67%

75% 74% 74%

73% 73%

$1,759

$1,843 $1,821 $1,816 $2,164

$0

$500

$1,000

$1,500

$2,000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)

Government Expenditure on Routine Immunization

Percentage of government funding RI (average in 70 selected countries)

Percentage of government funding RI (average for all countries)

Aggregated Expenditure in (70) selected countries (Millions US$)

20

The aggregated government expenditures on RI for 70 selected countries8, with a full time-series,

increased between the years 2010 and 2014. The increase did not occur in a consistent manner

however, with the expenditure increasing initially from $1,759 million to $1,843 million between

2010 and 2011, after which it saw a slight decline over the next two years to $1,816 million (2013)

before a sharp increase in 2014 to $2,164 million. This substantial increase towards the end of the

five years was driven mainly by the region of the Americas who reported an increase in aggregate

expenditure of over $300 million between 2013 and 2014.

8 Cfr. Table 1

21

Government Expenditure on Vaccines

Table 11 – Government expenditure on vaccines

Indicators 2010 2011 2012 2013 2014

% of total vaccine expenditure funded by government in the region (average)

-Global (194) 73% 70% 69% 70% 70%

-AFR (46) 42% 38% 34% 37% 37%

-AMR (35) 96% 90% 90% 93% 95%

-EMR (22) 78% 68% 68% 70% 69%

-EUR (53) 91% 91% 88% 89% 89%

-SEAR (11) 64% 60% 57% 55% 64%

-WPR (27) 69% 70% 73% 75% 73%

-Gavi (73) 40% 33% 31% 34% 35%

% of total vaccine expenditure funded by government in selected countries (average)

-Global (70 countries) 66% 61% 61% 63% 64%

Aggregated expenditure on vaccines in selected countries (Millions US$)

-Global (70 countries) 1,535 1,623 1,570 1,584 1,893

-AFR (18 countries) 28 24 28 32 32

-AMR (24 countries) 990 1,047 973 1,009 1,320

-EMR (7 countries) 35 39 53 57 68

-EUR (7 countries) 112 117 102 95 86

-SEAR (7 countries) 93 105 115 100 93

-WPR (7 countries) 277 291 300 291 294

-Gavi (38 countries) 115 101 101 107 113

Government expenditure on vaccines Per Live Birth in selected countries (Population Weighted Average US$)

-Global (70 countries) 31.6 33.0 31.4 31.1 36.6

-AFR (18 countries) 3.1 2.5 2.9 3.3 3.2

-AMR (24 countries) 137.5 145.0 132.9 135.5 174.8

-EMR (7 countries) 9.4 10.2 13.7 14.7 17.4

-EUR (7 countries) 160.0 161.4 136.5 123.6 109.3

-SEAR (7 countries) 9.6 10.7 11.4 9.8 8.9

-WPR (7 countries) 15.3 15.9 16.2 15.4 15.4

-Gavi (38 countries) 6.8 6.8 6.7 6.3 6.0

22

Figure 2 – Global – Government expenditure on vaccines

The average percentage of government funding for vaccines declined over the period between 2010

and 2014, from 73% to 70%. The trend is somewhat irregular as the percentage initially drops from

73% in 2010 to 70% in 2011 and further to 69% the following year; but rises to 70% in 2013 and then

remains at 70% for 2014. Whilst the trend fluctuates, the magnitude of change between years is

relatively low and so it can be said that the percentage of government funding vaccines remains

stable throughout the five year period.

The region of the Americas reported the highest proportion of government funding vaccines

throughout the years of the analysis, with the European region not far behind. Once again these

results are to be expected given the high and upper middle income status which the majority of the

countries in these regions reside in, leading to only a small amount of Gavi support in the region and

little reliance on external funding for vaccines.

The African region reported the lowest proportion of government funding for vaccines, with a

decline reported over the five years from 42% to 37%. Given the high amount of Gavi support in this

region, it would be expected that the proportion of government funding would be relatively lower

than other regions.

The Gavi eligible countries display a decreasing trend in percentage of vaccines funded by

government over the five years. Whilst this would seem to be counterintuitive to the Gavi co-

financing mechanism, it is most likely due to the large number of Low and Lower middle income

countries who are still introducing new and underused vaccines into their immunization

programmes, but are paying relatively low amounts due to co-financing arrangements still being in

their infancy.

66% 61% 61%

63% 64%

73% 70%

69%

70% 70%

$1,535 $1,623

$1,570 $1,584 $1,893

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding vaccines (average in 70 selected countries)

Percentage of government funding vaccines (average over all countries)


23

Figure 3 – Global – Government expenditure on RI per live birth

Figure 3 shows the population weighted average government expenditure on routine immunization

per live birth for 70 selected countries, as well as the proportion of these RI funds directed towards

the procurement of vaccines.

The government expenditure on RI per live birth increased over the five year period, albeit with a

fluctuating trend, alongside this the government expenditures on vaccines per live birth moved in

tandem allowing for the proportion of government expenditure on RI funding vaccines to remain

relatively stable at approximately 87%.

87% 88% 86% 87% 87%

$36.2 $37.5

$36.4 $35.6

$41.9

0

5

10

15

20

25

30

35

40

45

2010 2011 2012 2013 2014

US$

Government Expenditure on Routine Immunization in (70) selected countries (PWA Per Live Birth, US$)

Share of expenditure on vaccines Share of expenditure on service delivery

24

Figure 4 – Global – Total expenditure on vaccines per live birth

Figure 4 shows the total expenditure on vaccines per live birth for 70 selected countries, which is

increasing over time. The trend for total expenditure per live birth is somewhat unusual as it does

not display a consistent upward trend which is what would be expected, but instead increased

initially from $36.3 in 2010 to $39.2 in 2011 after this however it dropped to $36.8 before steadily

increasing over the next two years; eventually reaching $44.4 in 2014.

During this time the government expenditures on vaccines per live birth followed a similar but

muted trend, fluctuating around $32 before increasing in 2014 to $36.6; this meant that the

percentage of total vaccine costs funded by government was somewhat erratic showing no

consistent pattern, but moving between 87% and 79%.

Whilst the trend in proportion of government funding vaccines is unstable, the magnitude is

relatively high which is encouraging – showing that collectively there are signs of high government

commitment and ownership over the vaccine financing aspects of immunization.

However, these global trends may mask the realities which regions and countries face and so it is

imperative to look closely at trends seen in the different regions in order to have a full overview of

current global trends in immunization financing.

87% 84% 85% 79% 82%

$36.3

$39.2 $36.8

$39.4

$44.4

0

5

10

15

20

25

30

35

40

45

50

2010 2011 2012 2013 2014

US$

Total Expenditure on Vaccines in 70 selected countries (PWA Per Live Birth, US$)

Government Expenditure on Vaccines Externally Funded Expediture on Vaccines

25

African Region


Income Classification Group Low Income Lower Middle Income Upper Middle Income High Income Total

Total no. of countries 25 13 8 1 47

Of which are Gavi eligible 25 11 1 0 37

Table 12 – African Region – Indicators summary

Indicators 2010 2011 2012 2013 2014

Line item in national budget for vaccines (No. of countries) 44 44 44 46 44

Government Routine Immunization Expenditures:

% of total RI funded by government in the region (average) 50% 48% 46% 40% 40%

% of total RI funded by government in (18) selected countries (average)

40% 35% 37% 36% 33%

Aggregated Expenditure in (18) selected countries (Millions US$) 52 49 50 52 58

Expenditure Per Live Birth in (18) selected countries (PWA US$) 5.7 5.3 5.3 5.3 5.8

Government Vaccine Expenditures:

% of total vaccines funded by government in the region (average) 42% 38% 34% 37% 37%

% of total vaccines funded by government in (18) selected

countries (average) 32% 24% 25% 27% 29%



DTP3 Coverage:

DTP3 Coverage in the region (%) 72 72 72 76 77

DTP3 Coverage in (18) selected countries (%) 75 77 80 79 82

Introduction of New and Underused Vaccines (Cumulative no. of countries):

Rotavirus 1 1 5 10 24

PCV 3 12 18 26 33

HPV 0 1 2 2 4

The 18 countries selected for analysis are listed in Table 12.

Most of the countries in the African region report having line items in their national budgets for

purchasing vaccines. The trend in number of countries reporting a line item for the purchase of

vaccines appears relatively stable over the period 2010-2014 at 44 countries, however this masks

the unstable trends that a number of countries are reporting; it appears that whilst some countries

are reporting to adding the line item in the national budget, others are dropping it in equal measure.

Two countries reported to dropping the line item between 2013 and 2014, they were The Congo and

South Africa.

26

Figure 5 – African Region – Government expenditure on RI

The government expenditures on RI showed signs of an overall increase over the period 2010 to

2014, from $52 million to $58 million. Initially, the aggregated expenditure dropped from $52 million

in 2010 to $49 million in 2011 after which it increased in a consistent manner over the remaining 3

years. The percentage of government funding for routine immunization in the region fell (on average)

over the five year period, showing a consistent decreasing trend from 50% in 2010 to 46% in 2012

after which it fell to 40% in 2013 and remained for 2014. Whilst governments are directing more and

more funds towards the routine costs of the immunization program, increasing amounts of external

support continue to diminish the overall proportion which is funded by government. Given that

routine immunization costs encompass the costs of vaccines, it seems that the decreasing trend in

percentage of government funding RI correlates with the increased introduction of new and

underused vaccines supported by donors.

40% 35%

37% 36% 33%

50% 48% 46% 40% 40%

$52 $49 $50

$52 $58

$0

$10

$20

$30

$40

$50

$60

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding RI (average % in 18 selected countries)

Percentage of government funding RI (average % in all countries)


27

Figure 6 – African Region - Government expenditure on vaccines

The percentage of reported government funding of vaccines (on average) decreased from 42% to 34%

over the period 2010 to 2012, after which it climbed to 37% in 2013 and 2014. However, during this

period the government expenditures on vaccines saw an overall increase overall albeit with a

somewhat fluctuating trend. Initially, the government expenditure on vaccines drops from $28

million in 2010 to $24 million in 2011, before increasing substantially over the next 2 years to $32

million in 2013 where it remains going into 2014. 30 countries in the region showed an increase in

government funding for vaccines when comparing their reported spending in 2014 with their

reported figures for 2010.

Whilst the government expenditure on vaccine exhibits an increasing trend, the overall decrease in

percentage of government funding vaccines comes mainly as a result of greater increases to total

expenditure on vaccines over the period 2010 to 2014. The increasing trend in expenditures in

vaccines is a result of the introduction of new and underused vaccines into African countries’ routine

immunization schedules. The number of countries in the region which have introduced PCV,

Rotavirus and HPV vaccines can be seen in Table 12 and can be seen to broadly comply with the

increasing trend in vaccine expenditures. All but 9 countries in the region are classified as Low or

Lower middle income countries, which is cause for Gavi eligibility in 38 countries. This high

proportion of Gavi support in the region serves to explain the high uptake of PCV and Rotavirus

vaccines and hence the escalating total expenditures.

32%

24% 25% 27%

29%

42% 38%

34% 37% 37%

$28

$24

$28

$32 $32

$0

$5

$10

$15

$20

$25

$30

$35

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding vaccines (average % in 18 selected countries)

Percentage of government funding vaccines (average % in all countries)


28

Table 13 – African Region - Government expenditure on RI per live birth

Country Income Status

2010 2011 2012 2013 2014

Trend between 2010 and

2014/2013

Percentage Change

Congo (The) LMIC (Gavi) 3.4 5.2 10.0 11.0 16.2 Increasing 378%

Mauritania LMIC (Gavi) 7.0 4.2 3.5 3.4 28.8 Increasing 312%

Eritrea LIC (Gavi) 0.7 2.7 2.8 2.9 2.9 Increasing 293%

Democratic Republic of the Congo LIC (Gavi) 0.7 0.7 1.6 1.8 1.3 Increasing 89%

Central African Republic LIC (Gavi) 0.6 1.2 0.5 0.9 1.1 Increasing 78%

Tanzania LIC (Gavi) 4.7 5.8 3.2 2.9 7.9 Increasing 68%

Rwanda LIC (Gavi) 6.0 6.5 7.2 7.5 7.4 Increasing 25%

Sao Tome and Principe LMIC (Gavi) 81.7 72.2 110.8 129.4 97.4 Increasing 19%

Côte d'Ivoire LMIC (Gavi) 7.9 5.2 14.3 12.1 8.1 Increasing 2%

Swaziland LMIC 56.9 71.6 61.2 58.1 51.7 Decreasing -9%

Burkina Faso LIC (Gavi) 6.2 6.5 5.7 5.0 5.5 Decreasing -12%

Cameroon LMIC (Gavi) 7.4 8.5 3.8 5.8 6.4 Decreasing -14%

Benin LIC (Gavi) 7.1 5.9 6.0 6.1 6.0 Decreasing -15%

Mali LIC (Gavi) 10.5 10.4 3.3 5.8 8.1 Decreasing -23%

Chad LIC (Gavi) 7.8 0.7 6.9 5.7 3.8 Decreasing -52%

Gabon UMIC 68.7 31.9 33.7 34.2 26.6 Decreasing -61%

Togo LIC (Gavi) 19.3 20.8 24.2 22.8 3.9 Decreasing -80%

Comoros LIC (Gavi) 17.3 13.2 9.2 4.4 2.1 Decreasing -88%

Population Weighted Average 5.7 5.3 5.3 5.3 5.8

WHO estimates in italics. Countries are in order of magnitude of change between the years 2010 and 2014.

Table 13 shows the government expenditure on RI per live birth, for 19 selected countries with a full

5 year time series. When viewing the two end points of data for each country, years 2010 and 2014

regardless of any inconsistent trend in between the two comparison years, it can be seen that 9

countries reported an increase in government expenditure on RI per live birth between 2010 and

2014, whilst 10 countries reported a decrease. The population weighted average government

expenditure per live birth remains relatively stable over the period 2011 to 2013 at $5.3, increasing

substantially to $5.8 per live birth in 2014.

29

Figure 7 – African Region - Government expenditure on RI per live birth

Figure 7 shows the government expenditure on routine immunization per live birth and the

allocation of funding between vaccines and service delivery.

Over the 5 year period, the proportion of funding towards vaccine expenditures showed a slightly

erratic trend, decreasing initially from 54% to 48% between 2010 and 2011, before increasing in a

fairly substantial manner over the next 2 years to 55% in 2012 and then 62% in 2013 - with the

converse of this being the trend in proportion funding vaccines. By 2014 the proportion of

government expenditure on routine immunization funding vaccine costs increased to 55%. The

overall increase in proportion of government funds directed towards vaccine costs is potentially a

result of the Gavi co-financing policy. Given the introduction of new and underused vaccines,

countries may have given priority to fulfil their co-financing obligations than investing funds for

strengthening service delivery.

54% 48% 55% 62% 55%

$5.7 $5.3 $5.3 $5.3

$5.8

$-

$1.0

$2.0

$3.0

$4.0

$5.0

$6.0

$7.0

2010 2011 2012 2013 2014

US$

Government Expenditure on Routine Immunization in 18 selected countries (PWA Per Live Birth, US$)

Share of government expenditure on vaccines Share of government expenditure on service delivery

30

Figure 8 - African Region - Total expenditure on vaccines per live birth

On figure 8 it can be seen that the total expenditure on vaccines per live birth increased in a fairly

consistent manner over the 5 year period - starting initially at $15 before rising to approximately $26

by 2014. Alongside this, the proportion of total expenditures on vaccines funded externally grew

from 80% in 2010 to 88% in 2014, with the converse effect being had on the proportion funded by

government. These trends are a clear result of the high amount of Gavi support in the region. Whilst

Total expenditure on vaccines per live birth increased over time, the actual government expenditure

on vaccines per live birth remained relatively stable for the 5 year period, at approximately $3.

Given the high amount of Gavi support, it would be expected that the Government expenditure on

vaccines per live birth will show an increasing trend in the future as per the co-financing policy.

Currently, as the majority of countries which receive Gavi support in the region are classified as Low

income, their co-financing amounts are still at an infant stage with only the minimum co-financing

amount being paid.

It should be noted that 19 countries in the African region defaulted on their Gavi co-financing

payments at least once between 2010 and 2014, with some countries defaulting more than once. A

number of countries in this region face a precarious financial situation in which they have very little

control over their budget allocations, and hence are unable to pay the full amount of their co-

financing share. This is likely to have had a distortive effect on the trend for government expenditure

on vaccines.

Economic growth in the region over time will lead to greater financial stability in these countries,

changes in Income classification and increases to co-financing amounts, which should be visible

through an increasing trend in government expenditures in vaccines in the JRF data.

20% 15% 17% 14% 12%

$15.4 $17.2 $17.0

$23.4

$26.3

0

5

10

15

20

25

30

2010 2011 2012 2013 2014

US$


Government Expenditure on Vaccines Externally Funded Expenditure on Vaccines

31


Table 14 – African Region – Reporting Statistics

All indicators (276)

2010 2011 2012 2013 2014

Missing 71 (26%) 66 (24%) 81 (29%) 56 (20%) 43 (16%)

Inconsistencies 20 (7%) 28 (10%) 18 (7%) 18 (7%) 18 (7%)

Estimates 42 (15%) 51 (18%) 46 (17%) 23 (8%) 7 (3%)

The reporting statistics for the African region, in Table 14, displays a substantial improvement in JRF

submissions over the period 2010-2014. The number of missing indicators has been reduced

markedly, with only 16% of indicators missing in 2014 compared to 26% in 2010. A slight drop

occurred in the number of inconsistencies reported. As a result of the improvements in reporting

and consistency of data, the number of estimates used by WHO has also seen a dramatic fall, from

15% of all indicators being estimated in 2010 to only 3% of indicators being estimated in 2014.

32

Region of the Americas


Income Classification Group Low Income Lower Middle

Income Upper Middle

Income High Income Total



Table 15 – Region of the Americas – Indicators summary

Indicators 2010 2011 2012 2013 2014 Line item in national budget for vaccines (No. of

countries) 31 30 31 30 31


% of total RI funded by government in the region (average)

95% 93% 94% 95% 95%


94% 91% 92% 94% 94%


1,076 1,128 1,070 1,076 1,419

Expenditure Per Live Birth in (24) selected countries (PWA US$)

149.5 156.2 146.2 144.6 187.9


% of total vaccines funded by government in the region (average)

96% 90% 90% 93% 95%

% of total vaccines funded by government in (24) selected countries (average)

95% 91% 91% 92% 94%


990 1,047 973 1,009 1,320


137.5 145.0 132.9 135.5 174.8

DTP3 Coverage:

DTP3 Coverage in the region (%) 94% 93% 94% 91% 90%

DTP3 Coverage in (24) selected countries (%) 94% 92% 92% 92% 90%


Rotavirus 15 15 16 16 17

PCV 13 17 21 22 24

HPV 3 5 7 11 15

The 24 countries selected for analysis are listed in Table 16

Of the 35 countries in the region of the Americas, 31 have reported to having a line item in the

national budget for the procurement of vaccines in 2014. Prior to this, the countries reporting a line

item fluctuated between 31 and 30 over the five year period (2010-2014). This trend is not due to

any single country, but rather a group of countries. Belize reported to dropping the line item in 2011,

33

before re-adding in 2014. Dominica reintroduced the line item in 2012 having dropped it in 2010,

and Saint Lucia dropped the line item in 2013. Canada and the USA are the only two countries to in

the region which have not reported any data for this indicator, whilst Haiti is the only country to

have never reported having a national budget line item for vaccines.

Figure 9 - Region of the Americas - Government expenditure on RI

Government expenditure on routine immunization in the 24 selected countries of the region of the

Americas increased significantly over the period 2010 to 2014, however during this time the trend in

expenditures was reported to being somewhat variable with an initial rise in expenditures from

$1,076 million in 2010 to $1,128 million in 2011 after which it declined to $1,070 in 2012, before

again rising to $1,076 million in 2013. In 2014 the government expenditure on routine immunization

increased dramatically by over $300 million to reach $1,419 million. Whilst the initial 4 years gave

way to an erratic trend, the magnitude of change between each year was relatively small and

relatively stable. The initial fluctuating trend was driven by a number of countries that reported

similarly unpredictable trends over the period 2010 to 2013 – these countries include but are not

limited to Brazil, Argentina, Columbia and Peru – all of which represent a significant proportion of

total spending within the region of the Americas. The spike in government expenditures seen at the

end of the five year period is driven primarily by Brazil which reported an increase in spending by

over $300 million between 2013 and 2014.

The percentage of routine immunization costs funded by government remained consistently high in

the region over the five year period, staying relatively stable around 95% for the majority of the time.

Given that the percentage of expenditures funded by government remains stable even when there

are significant increases to government expenditure, which can be seen in 2014, this implies that

94% 91% 92% 94% 94%

95% 93% 94% 95% 95%

$1,076 $1,128 $1,070 $1,076

$1,419

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

$2,000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)




Aggregated Government Expenditure in (24) selected countries

34

total expenditure on routine immunization moves in unison with government expenditure, with

each increasing or decreasing in parallel.

Figure 10 - Region of the Americas - Government expenditure on vaccines

The aggregated government expenditure on vaccines displayed an extremely similar trend to

government expenditure on routine immunization (Figure 9), with both moving in tandem

throughout the five year period. The same, broadly increasing, trends can be seen in both graphs

looking at expenditures on RI and on vaccines which shows that the costs of vaccines represent a

large proportion of the costs of RI; this shows that the countries driving the trend in expenditures for

vaccines are the same as those for routine immunization expenditures.

The percentage of government funding for vaccines was also extremely high in the region, between

the five years however the percentage funding vaccines fell by 1 percentage point from 96% in 2010

to 95% in 2014. The intervening years saw the percentage drop to 90% in 2011 where it remained

the same for an additional year before rising to 93% in 2013 and then 95% in 2014. Only 6 of the 35

countries in this region are Gavi eligible with all but one being in the advanced co-financing group

(Accelerated Transition) paying a high proportion of the vaccine costs – helping explain the

extremely high average in percentage of government funding vaccines in the region.

95%

91% 91%

92% 94%

96%

90% 90%

93% 95%

$990 $1,047 $973

$1,009

$1,320

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

$2,000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding vaccines (average % in 24 selected countries)


Aggregated Government Expenditure in (24) selected countries

35

Table 16 – Region of the Americas - Government expenditure on RI per live birth


2010 2011 2012 2013 2014


2014/2013

Percentage Change

Argentina UMIC 77.5 263.2 214.9 157.4 245.3 Increasing 216%

Dominica UMIC 16.1 53.6 58.0 50.4 43.1 Increasing 167%

Dominican Republic UMIC 14.6 20.3 28.3 85.0 38.1 Increasing 160%

Paraguay LMIC 57.3 132.3 244.4 182.4 117.6 Increasing 105%

Guatemala LMIC 32.3 32.8 72.8 52.9 61.3 Increasing 90%

Colombia UMIC 77.7 134.0 124.6 153.6 134.6 Increasing 73%

Venezuela UMIC 52.5 78.1 81.2 73.6 87.8 Increasing 67%

Saint Vincent and The Grenadines

UMIC 25.2 17.0 22.2 25.0 39.1 Increasing 55%

Uruguay HIC 150.8 173.9 169.0 163.9 210.1 Increasing 39%

Panama UMIC 247.8 354.3 317.0 345.7 344.6 Increasing 39%

Bahamas HIC 116.9 97.3 123.7 120.5 161.7 Increasing 38%

Bolivia LMIC (Gavi) 50.5 52.2 48.0 42.4 63.1 Increasing 25%

Cuba UMIC (Gavi) 187.9 179.1 156.6 128.8 221.0 Increasing 18%

Brazil UMIC 237.4 195.8 165.8 190.9 270.7 Increasing 14%

Honduras LMIC (Gavi) 59.2 72.0 50.3 58.3 66.4 Increasing 12%

Nicaragua LMIC (Gavi) 84.7 64.1 66.6 86.0 92.4 Increasing 9%

Guyana LMIC (Gavi) 110.6 77.0 121.7 134.2 120.1 Increasing 9%

Saint Lucia UMIC 27.4 19.6 29.7 39.8 26.8 Decreasing -2%

Grenada UMIC 50.8 36.5 55.0 36.5 48.2 Decreasing -5%

Saint Kitts and Nevis HIC 28.2 22.5 24.6 30.3 26.1 Decreasing -7%

El Salvador LMIC 111.1 134.7 92.5 105.6 95.5 Decreasing -14%

Belize UMIC 57.6 69.4 38.3 41.2 47.3 Decreasing -18%

Peru UMIC 227.0 150.4 202.3 98.1 115.2 Decreasing -49%

Jamaica UMIC 196.4 76.7 81.4 83.9 41.0 Decreasing -79%


WHO estimates in italics.

Countries are in order of magnitude of change between the years 2010 and 2014.

Table 16 shows the government expenditure on routine immunization per live birth for 24 countries

in the region, who exhibited a full time series. Looking at the trend between 2010 and 2014, it can

be seen that 17 countries displayed an increasing trend, whilst 7 reported a decreasing trend. The

population weighted average over the period 2010 to 2014 is unpredictable in terms of trend, but

remains relatively stable over the initial 4 years (2010-2013) however increases significantly from

$144.6 in 2013 to $187.9 in 2014. The spike in 2014 comes mainly as a result of both Argentina and

Brazil increasing their expenditures between 2013 and 2014.

36

Figure 11 – Region of the Americas – Government expenditure on RI per live birth

Figure 11 above, presents the government expenditure on routine immunization per live birth in the

region, and the proportion of funding that is allocated towards vaccine costs and the remaining

which goes towards immunization service delivery. Over the five year period government

expenditure on RI per live birth increased; an extremely high proportion of the expenditures were

used for the purchase of vaccines, with the proportion funding service delivery never increasing

beyond 9% over the five year period. The proportion funding vaccines remains at a high level, even

in 2014 when government expenditure on RI increases dramatically, this points towards a fairly

stable relationship between the funding for vaccine and funding for RI.

This high proportion of routine immunization funding going towards vaccine costs helps to explain

the similar trends of expenditure in figures 9 and 10.

92% 93% 91% 94%

93%

$149.5 $156.2

$146.2 $144.6

$187.9

$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

$200

2010 2011 2012 2013 2014

US$

Government Expenditure on Routine Immunization in (24) selected countries (Per Live Birth, US$)

Share of government expenditure on vaccines Share of government expenditure on service delivery

37

Figure 12 – Region of the Americas – Total expenditure on vaccines per live birth

Figure 12 shows that total expenditure on vaccines increased over the 5 year period, albeit with a

fluctuating trend. Initially, expenditure increases from $139.5 in 2010 to $149.7 in 2011, before

dropping to $135.9 in 2012. By 2013 the expenditure increased to $147.2 and even further the

following year to $182.9 – at no point during this time did the percentage of vaccines funded by

government drop below 92%. The countries in this region consistently report to funding large

proportions of vaccine costs with relatively limited external donor support – in fact the majority of

countries are of middle or high income and Gavi support is limited to 6 countries: Bolivia, Cuba,

Guyana, Haiti, Honduras and Nicaragua.

The consistently high proportion of immunization costs being met by domestic sources, seen in

figures 9, 10, 12 show clearly ownership of immunization programs and services in the region. In

addition to this the increasing trends in government expenditures seen in figures 9-12 show an

increasing financial commitment towards immunization.


Table 17– Region of the Americas – Reporting statistics


2010 2011 2012 2013 2014

Missing 37 (18%) 30 (14%) 36 (17%) 47 (22%) 42 (20%)


Estimates 28 (13%) 21 (10%) 15 (7%) 18 (9%) 5 (2%)

The reporting statistics for the region of the Americas show no real improvement in reporting in

terms of missing indicators over the five year period, which displayed an irregular trend with slight

99% 97% 98% 92%

96%

$139.5 $149.7

$135.9 $147.2

$182.9

0

20

40

60

80

100

120

140

160

180

200

2010 2011 2012 2013 2014

US$

Total Expenditure on Vaccines in (24) selected countries (PWA Per Live Birth, US$)


38

variation from year-to-year. 10% of all indicators reported were regarded as inconsistent in 2010,

whereas only 4% were regarded as inconsistent in 2014. However, this this should be interpreted

with caution as there has been large variation between the years in the number of inconsistencies

and whilst there may have been improvement in 2014 but this is not to mean that these

improvements will carry-over into 2015 data.

39

Eastern Mediterranean Region



Income Upper Middle




Table 18– Eastern Mediterranean Region – Indicators summary

Indicators 2010 2011 2012 2013 2014





69% 66% 71% 75% 71%


45 48 66 70 85


12.1 12.6 17.2 17.9 21.7


% of total vaccines funded by government in the region (average)

78% 68% 68% 70% 69%


65% 59% 60% 62% 63%


35 39 53 57 68


9.4 10.2 13.7 14.7 17.4

DTP3 Coverage:





PCV 7 8 9 11 13

HPV 0 0 0 1 1

The 7 countries selected for analysis are listed in Table 19

Of the 21 countries in the Eastern Mediterranean region, 19 countries reported having a line item in

the national budget for the procurement of vaccines in 2014. The number of countries reporting the

line item remained fairly stable over the period 2010 to 2014, at 19 with the number dropping to 18

in 2012 but then rising to 19 once again the following year (2013). During this time, Somalia

40

consistently reported no line item whatsoever whereas Syria and Djibouti both displayed

inconsistent trends in their reporting. Syria reported the inclusion of the line item up until 2011 after

which it was not reported for 2012, but then reported in 2014. Similarly, Djibouti first reported to

having a line item in 2013 but then reported to dropping it the following year (2014).

Figure 13 - Eastern Mediterranean Region - Government expenditure on RI

The period 2010-2014 saw the aggregated government expenditures on RI increase year-upon-year

for 7 selected countries in this region. Rising by $40 million over five years, the expenditure was

initially at $45 million in 2010 increasing slightly to $48 million in 2012; the following three years saw

substantial increases with expenditure eventually reaching $85 million by 2014. All of the 7 selected

countries included in the analysis reported an increase in absolute government expenditures on RI

between 2010 and 2014, with Iran in particular driving up the region’s aggregated expenditures with

increases of over $20 million between 2012 and 2014.

The five years saw the percentage of government funding RI increase by 2 percentage points overall,

from 69% in 2010 up to 71% in 2014. The intervening period saw a fluctuating trend, with the

percentage dropping to 66% in 2011, before rising over the next two years to reach 75% in 2013

where the percentage figure peaks and falls to 71% the next year. The overall rise in percentage

funded by government is relatively low, given the substantial increases in actual government

expenditure this indicates that external funding for routine immunization grew at a similar rate.

69% 66% 71%

75%

71%

73% 70% 75%

73%

74%

$45 $48

$66

$70

$85

$0

$20

$40

$60

$80

$100

$120

$140

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)





41

Figure 14 - Eastern Mediterranean Region - Government expenditure on vaccines

The aggregated government expenditures on vaccines in Figure 14 follow the same trend as the

expenditures on RI seen in figure 13, with consistent year-upon-year increases over the whole 5 year

period. The government expenditure on vaccines almost doubles, going from $35 million in 2010 to

$68 million in 2014. Given the close relationship between the government expenditures on RI and

government expenditures on vaccines, it seems clear that the vaccine costs form a large proportion

of the overall routine immunization costs.

The percentage of vaccine costs funded by government can be seen to fall drastically over the five

year period, starting initially at 78% in 2010 and then dropping by 10 percentage points for the next

year (2011), after which the figure remained relatively stable but increased slightly over the next 3

years to reach 69% in 2014.

Only 2 of the 21 Eastern Mediterranean countries are classified as Low income, with the majority (13)

classified as middle income, and 6 being of High income – this serves to explain the relatively high

proportion of government funding for routine immunization and vaccines, in comparison to other

regions with relatively lower income.

65%

59% 60% 62% 63%

78% 68% 68% 70% 69%

$35 $39

$53

$57

$68

$0

$20

$40

$60

$80

$100

$120

$140

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)





42

Table 19 – Eastern Mediterranean Region - Government expenditure on routine immunization per live birth

Country Income Status 2010 2011 2012 2013 2014


2014

Percentage Change

Iran UMIC 12.3 12.2 17.9 18.1 29.4 Increasing 140%

Djibouti LMIC (Gavi) 39.9 34.3 69.6 78.2 82.2 Increasing 106%

Tunisia UMIC 14.9 31.6 29.3 28.7 28.4 Increasing 90%

Yemen LMIC (Gavi) 5.1 5.3 7.4 7.5 8.0 Increasing 56%

Sudan LMIC (Gavi) 3.5 3.0 6.8 5.8 5.0 Increasing 44%

Jordan UMIC 78.1 75.0 86.8 98.5 97.0 Increasing 24%

Lebanon UMIC 57.2 44.7 48.0 51.4 52.6 Decreasing -8%


WHO estimates in italics

Countries are in order of magnitude of change between 2010 and 2014

The table above shows the government expenditure on routine immunization per live birth for the 7

selected countries in the region who exhibited a full-time series. 6 countries reported to increasing

their expenditures per live birth between 2010 and 2014, whilst only Lebanon did not. It should be

noted that earlier it was stated that all 7 countries showed and increasing trend in absolute

government expenditures on RI, however when using the live births denominator Lebanon’s

government expenditure on RI per child can be seen to diminish between the years 2010 and 2014.

The population weighted average expenditure of this group of countries show a consistently

increasing trend, with substantial magnitude of change over the years from $12.1 in 2010 to $21.7 in

2014.

43

Figure 15 - Eastern Mediterranean Region - Government expenditure on RI per live birth

Figure 15 shows the government expenditure on routine immunization per live birth in 7 selected

countries in the Eastern Mediterranean region, and the proportion of funds directed towards

vaccine costs and service delivery costs. It can be seen that the share of expenditure on vaccines

remained relatively high throughout the 5 year period at approximately 80%, which helps to explain

the similarity in government expenditure on RI and vaccine trends seen in figures 13 and 14.

Given that the government expenditure on vaccines and government expenditure on service

delivery grow in proportion to one and other, it shows that there seems to be little evidence of a

substitution effect occurring between the two. 6 of the 21 countries in the region are Gavi eligible,

they are Afghanistan, Djibouti, Pakistan, Somalia, Sudan and Yemen.

78% 81% 80% 82%

80%

$12.1 $12.6

$17.2 $17.9

$21.7

0

5

10

15

20

25

30

35

2010 2011 2012 2013 2014

US$



44

Figure 16 - Eastern Mediterranean Region - Total expenditure on vaccines per live birth

Figure 16 shows the total expenditure on vaccines per live birth in the 7 selected countries

increasing substantially over the years 2010 to 2013 from $16.4 to $33.2 in a consistent manner,

before falling slightly in 2014 to $31.8. Throughout the increases to total expenditure we see an

inconsistent trend emerging in the proportion of vaccine costs funded by government. As total

expenditure on vaccines grew from $16.4 in 2010 to $24.7 in 2011, government expenditure was

unable to grow at such a rate and so proportion funded by government dropped from 57% to 41%

despite government funding increasing slightly in absolute terms. The following year (2012) the

government expenditures increased at a faster rate than the total expenditures leading to the

proportion funded by government to increase to 50%. In 2013 the opposite occurred, with the

proportion funded by government decreasing once again; whilst in 2014 total expenditure dropped

from $33.2 to $31.8, government expenditure on vaccines per live birth retained its upward

trajectory and proportion of vaccine costs funded by government increased to 55%.

Whilst the overall amount of vaccines funded by government has decreased over the 5 years in the

region, it has done well to keep on par with increases to externally funded expenditure on vaccines;

with governments showing good commitment to immunization by not only increasing domestic

expenditures on vaccines but also domestic expenditures on routine immunization.

57% 41% 50% 44%

55%

$16.4

$24.7 $27.4

$33.2 $31.8

0

5

10

15

20

25

30

35

2010 2011 2012 2013 2014

US$



45


Table 20 - Eastern Mediterranean Region - Reporting statistics


2010 2011 2012 2013 2014

Missing 59 (45%) 69 (52%) 59 (45%) 53 (40%) 56 (42%)


Estimates 34 (26%) 27 (20%) 27 (20%) 21 (16%) 14 (11%)

The completeness of reporting in the Eastern Mediterranean region did not change greatly between

the years 2010 to 2014, with the number of missing varying between 42% of all indicators and 52%.

The lack of reporting in this region can be seen as a major concern, especially when considering that

in 2014, 8% of all indicators were regarded as inconsistent. Whilst the number of inconsistencies has

decreased over the five year period, the biggest improvement was seen early on between the years

2010 and 2011, where the percentage of indicators identified as inconsistent dropped from 15% to

5%, after which it increased and remained stable around 9%.

46

European Region



Income Upper Middle




Table 21 – European Region – Indicators summary

Indicators 2010 2011 2012 2013 2014





85% 84% 79% 80% 78%






82% 82% 80% 82% 76%



DTP3 Coverage:





PCV 23 25 25 28 32

HPV 21 23 24 26 28

The 7 countries selected for analysis are listed in Table 22.

The number of countries reporting a line item in the national budget for the procurement of

vaccines increased from 42 to 43 over the period 2010 to 2014, however during this time a number

of countries displayed inconsistent reporting patterns. Bosnia and Herzegovina initially reported to

having the line item in 2010, before dropping the line item in 2011 and then reporting to adding it

once again the following year (2012). Malta also displayed intermittent reporting, including the line

47

item in 2011 before reporting no line item in 2013. During the 5 year period Slovakia began

reporting a line item in 2012, whilst Slovenia failed to report in 2014.

Figure 17 - European Region - Government expenditure on RI

The aggregate government expenditure on routine immunization for 7 selected countries in the

European region displayed a decreasing trend over the period 2010 to 2014. The government

expenditure on RI initially increased from $147 million in 2010 to $159 million in 2011, after which

consistent year upon year decreases were seen with the expenditure level eventually ending at $136

million in 2014. Of the 7 selected countries 6 reported a decreasing trend between the years 2010

and 2014, with the Netherlands dropping their expenditures on routine immunization by

approximately $10 million which was the main driving force behind the overall decline seen in figure

17.

The percentage of RI costs being funded by government remained very high in the region for the

whole 5 year period. The percentage initially dipped from 92% in 2010 to 91% in 2011 where it

remained for the following year and then it declined further to 89% in 2013 before rising to 92%

again in 2014. The majority of the countries in this region are classified as High income (33 countries),

and so there are fewer countries that are reliant on external support for immunization in

comparison to the African and Eastern Mediterranean regions. Whilst overall government

expenditure on RI diminished in the countries, the percentage funded by government remained

relatively stable.

85% 84% 79% 80% 78%

92% 91% 91% 89% 92%

$147 $159 $149 $144 $136

$0

$50

$100

$150

$200

$250

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)





48

Figure 18 - European Region - Government expenditure on vaccines

The aggregated government expenditure on vaccines in the 7 selected countries followed the same

trend as the government expenditure on RI seen in figure 17. The government expenditure increases

slightly from $112 million in 2010 to $117 million in 2011, after which it decreased in a consistent

manner over the following 3 years eventually dropping to $86 million.

Over the 5 year period, the percentage of vaccines being funded by government in the region

decreased by 6 percentage points, starting initially at 82% in 2010 and experiencing a fluctuating

trend moving between 82% and 80% between the years 2010 and 2013 before dropping to 76% in

2014.

Table 22 – European Region - Government expenditure on routine immunization per live birth


2010 2011 2012 2013 2014


2014

Percentage Change

Georgia LMIC (Gavi) 33.8 46.8 17.5 38.9 59.8 Increasing 77%

Bulgaria UMIC 239.5 415.2 344.3 221.6 344.5 Increasing 44%

Iceland HIC 244.0 350.1 406.5 364.9 319.3 Increasing 31%

Andorra HIC 806.4 869.1 808.0 849.3 743.1 Decreasing -8%

The Netherlands HIC 684.1 681.9 668.8 679.1 600.9 Decreasing -12%

Tajikistan LIC (Gavi) 5.5 6.4 3.7 4.0 4.4 Decreasing -20%

Azerbaijan UMIC (Gavi) 39.8 34.2 29.1 26.4 9.4 Decreasing -76%

Population Weighted Average 210.0 220.8 198.9 186.4 173.1 WHO estimates in italics


82% 82% 80% 82% 76%

91% 91% 88% 89% 89%

$112 $117

$102 $95 $86

$0

$50

$100

$150

$200

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)





49

Table 22 shows the government expenditures on routine immunization per live birth for the 7

selected countries in the region, and it can be seen that 3 of these countries reported an increasing

trend in RI expenditures when comparing the figure reported in 2010 with that of 2014, whilst 4

reported a decreasing trend. Of those with the decreasing trend, the Netherlands displayed a large

fall in government expenditure on RI per live birth, dropping their expenditure by 12% between

2010 and 2014; given the size and magnitude of investment by this country it had considerable

influence over the population weighted average that was calculated. The PWA initially saw an

increase over the years 2010 to 2011 from $210.0 to $220.8, which is attributable to Bulgaria who

showed a similar increase. The following years saw both Bulgaria and the Netherlands reporting

year-upon-year declines having a substantial effect on the overall PWA trend.

Figure 19 - European region - Government expenditure on RI per live birth

Figure 19 shows the government expenditure on RI per live birth in the 7 selected countries, and the

proportion of funding split between vaccine purchases and service delivery spending. It can be seen

that whilst declines in government expenditure on RI per live birth occurred it was mainly caused by

a reduction in government spending on vaccines. The actual government expenditure on service

delivery per live birth remained relatively constant at around $50 per live birth.

76% 73% 69% 66% 63%

$210.0 $220.8

$198.9 $186.4

$173.1

0

50

100

150

200

250

2010 2011 2012 2013 2014

US$



50

Figure 20 - European Region -Total expenditure on vaccines per live birth

The proportion of total expenditure on vaccines per live birth funded by government remained

consistently high among the 7 selected countries over the 5 year period, at approximately 96%

before dropping to 94% in 2014. The total expenditure on vaccines per live birth was initially stable

from 2010 to 2011, however after this point both the total expenditure and government

expenditure on vaccines fell substantially year-upon-year but remained proportional to each other.

In 2014 the total expenditure per live birth dropped to $116.4.

The trend in both government expenditures and total expenditures on RI and vaccines seen in

figures 17 -20 both show a declining trend. It must be remembered that the countries included in

the expenditure calculations were those which reported a full time-series for the 3 indicators

(government expenditure on vaccines, government expenditure on RI, and total expenditure on

vaccines. Unfortunately, the reporting of the JRF indicators seems to be a low priority for many high

income countries and so there is relatively less data for this region. Whilst the analysis conducted

here may be an accurate representation of the expenditures in the selected countries, it may

potentially present a distorted view over this region’s expenditures.

However, decreasing expenditures on vaccines in high and middle income countries could perhaps

be a product of the decreasing vaccine prices, and this would have considerable influence over the

government expenditure on RI (as seen in figure 20) causing a decreasing trend in this indicator as

well.

96% 97% 96% 96% 94%

$166.3 $166.9

$142.0 $128.9

$116.4

0

50

100

150

200

250

2010 2011 2012 2013 2014

US$



51


Table 23 – European Region – Reporting statistics


2010 2011 2012 2013 2014

Missing 191 (60%) 201 (63%) 196 (62%) 199 (63%) 197 (62%)


Estimates 69 (22%) 72 (23%) 61 (19%) 60 (19%) 56 (18%)

The reporting statics for the European region are very alarming as the percentage of all indicators

that were not reported remained extremely high over between 2010 and 2014 at approximately

60%. The bulk of the missing indicators come about due to a lack of reporting in high income

countries. Of the indicators that have been reported, the number of which have been identified as

inconsistent also did not show any improvement, but it must be said that the percentage of

inconsistent indicators is relatively low at between 3% and 5% over the five years, which is

encouraging as it can be said that although the quantity of indicators being reported is low, the

quality of the reporting remains high. Due to the high number of missing indicators, this has led to a

high number of WHO estimates being calculated with approximately 20% of all indicators in the

region being estimated by WHO every year.

The lack of reporting in this region has had a clear effect on the trend analysis, with only few

countries reporting fully for all indicators, the resulting analysis is not fully representative of the

region.

52

South Eastern Asia Region





Table 24 – South Eastern Asia Region – Indicators summary

Indicators 2010 2011 2012 2013 2014




% of total RI funded by government in (7) selected countries (average) 62% 53% 57% 68% 60%






62% 57% 50% 54% 64%



DTP3 Coverage:




Rotavirus 0 0 0 0 0

PCV 0 0 0 0 0

HPV 1 1 1 1 1

The 7 countries selected for the analysis are listed in Table 25

All 11 countries in the South Eastern Asian region had reported the inclusion of a line item in the

national budget for the procurement of vaccines in 2014. In 2010 Myanmar was the only country in

the region to have not reported the line item, which they did report from 2012 and onwards.

53

Figure 21 - South Eastern Asia Region - Government expenditure on RI

The proportion of expenditure on routine immunization funded by government in the region shows

an overall decrease of 6 percentage points between 2010 and 2014, and during this time a

fluctuating trend can also be observed. In 2010 the average in RI costs funded by government was 69%

which then decreased over the following 2 years to reach 62% in 2012, after which the figure rose

sharply to 72% in 2013 before decreasing to 63% in 2014. A significant number of countries in the

South Eastern Asia region appear to have reported fluctuating trends for this indicator; very few

countries show any signs of consistent increases/decreases to share of government funding.

The government expenditures on RI of 7 selected countries dipped slightly. Initially, the expenditures

increased from $125 million to $146 million over the years 2010 to 2012, increasing very slightly

again the next year to $147 million before dropping substantially to $123 million in 2014. The initial

increase is attributable to Thailand which increased its domestic expenditures by approximately $15

million between 2010 and 2013, however following this expenditure was reduced in 2014. The main

driving force behind the late reduction in overall expenditures was Indonesia which reported a

reduction in spending by approximately $18 million between 2013 and 2014.

62% 53%

57%

68% 60%

69% 63% 62%

72%

63%

$125 $128 $146 $147

$123

$0

$50

$100

$150

$200

$250

$300

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)





54

Figure 22 - South Eastern Asia Region - Government expenditure on vaccines

In 2014 the proportion of government funding for vaccines was 64%, the same figure it had been at

in 2010. However this masks the trend in the intervening years where a consistent decrease

occurred between 2010 and 2013 causing the percentage to drop to 55% in 2013 before increasing

to 64% again in 2014. This untoward trend could possibly be a result of the distribution of different

Gavi co-financing groupings across the countries in the region. Two countries are classified in the

Low income group, three in Phase 1, two in Phase 2, and two in Phase 3. Countries in the Low

income Co-financing group could potentially see a decreasing trend in the share of vaccine costs

funded by government as they continue to introduce new and underused vaccines, whilst the Phase

2 and 3 countries an increasing trend would be expected over time – which complicates the

interpretation of the average trend seen over the region.

During the 5 year period the government expenditure on vaccines for 7 selected countries in the

region saw an unusual trend in which increases were reported over the years 2010 to 2012 from $93

million to $115 million –representing the peak of domestic expenditures on vaccines during the 5

years. From 2012 onwards the domestic expenditures reported a decreased by over $22 million,

returning once again to $93 million in 2014.

The unusual trend in government expenditures comes quite unexpected given the high amount of

Gavi eligibility; with 9 of the 11 countries in the region receiving Gavi support. Of the 7 countries

included in the analysis 6 are Gavi eligible, Thailand being the only one that is not eligible. Given

Thailand’s relatively high income within the region it is the country which is steering the expenditure

on figures 21 and 22. It would be expected that the remaining Gavi eligible countries would be

contributing greater domestic financing for vaccines, but this does not seem to be the case.

62% 57% 50%

54%

64% 64% 60% 57%

55% 64%

$93 $105 $115

$100 $93

$0

$50

$100

$150

$200

$250

$300

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)





55

Table 25 - South Eastern Asia Region - Government expenditure on RI per live birth


2010 2011 2012 2013 2014


2014

Percentage Change

Democratic People’s Republic of Korea

LIC (Gavi) 4.31 14.64 26.01 24.14 23.40 Increasing 443%

Thailand UMIC 32.43 35.20 53.58 50.26 45.58 Increasing 41%

Bangladesh LIC (Gavi) 8.22 7.80 6.42 5.38 7.72 Decreasing -6%

Indonesia LMIC (Gavi) 12.19 14.11 13.35 12.65 8.91 Decreasing -27%

Sri Lanka LMIC (Gavi) 34.85 9.52 25.62 42.79 19.43 Decreasing -44%

Nepal LIC (Gavi) 8.13 4.86 3.46 8.28 3.81 Decreasing -53%

Timor-Leste LMIC (Gavi) 32.03 9.71 5.25 7.62 8.42 Decreasing -74%




The Table above shows the government expenditures on Routine Immunization per live birth for 7

selected countries in the region. The majority of the countries (5 countries) reported a decreasing

trend between 2010 and 2014. The population weighted average calculated over these countries

show an inconsistent trend; increases in expenditure can be seen to occur over the years 2010 to

2012, driven mainly by Thailand and Sri Lanka. A significant drop occurs after 2013 to $11.7 from

$14.3, which influenced by the trends of Indonesia and Sri Lanka.

Figure 23 - South Eastern Asia Region - Government expenditure on RI per live birth

74% 82% 79% 68% 76%

$12.9 $13.1

$14.5 $14.3

$11.7

0

2

4

6

8

10

12

14

16

18

2010 2011 2012 2013 2014

US$



56

Figure 23 shows the government expenditure on RI per live birth for 7 selected countries in the

region, and in addition displays the proportion of domestic RI expenditures which are directed

towards vaccine costs and the proportion funding service delivery costs. It can be seen that

government expenditure on vaccines follows the same trend as the expenditure on RI, increasing up

until 2012 at which point it peaks and subsequently declines to its lowest in 2014. During this time

the proportion funding vaccines displayed irregular trend moving between 68% and 82%, in which it

shows no discernible relationship with the expenditure on vaccines, or the expenditure of RI.

Figure 24 - South Eastern Asia Region - Total expenditure on vaccines per live birth

Figure 24 shows the total expenditure on vaccines per live birth of 7 selected countries and the

proportion which is externally funded and domestically funded. There is an overall downward trend

in total expenditures on vaccines; after initially rising from $15.0 to $16.0 in 2010-2011, the

following years present consistent year-upon-year decreases falling to $14.6 in 2013 and then an

even steeper fall is seen in 2014 with expenditure slumping to $12.0. Of the 7 countries included in

the analysis 4 showed a decreasing overall trend in total expenditure per live birth between 2010

and 2014; Indonesia and Bangladesh form part of this group and have great influence in causing the

downward trend in total expenditure.

The government expenditure on vaccines per live birth increases steadily over the years 2010 to

2012 where it peaks and then subsequently declines over the years 2013 and 2014. When examining

the government expenditures alongside the total expenditures on vaccines, the proportion of total

expenditures on vaccines funded by government fluctuates between 64% and 77% over the five year

period showing no discernible trend in relation to either expenditure indicator.

64% 67% 77%

67% 74%

$15.0 $16.0 $14.9 $14.6

$12.0

0

2

4

6

8

10

12

14

16

18

2010 2011 2012 2013 2014

US$



57

It can be seen in Table 24 that only one country in the region has introduced HPV (Bhutan), whilst all

other countries have not introduced this vaccine, Rotavirus vaccine or Pneumococcal conjugate

vaccine all of which are relatively expensive vaccines supported by Gavi. This potentially explains

why there have been no significant increases to total expenditure on vaccines in this region.


Table 26 - South Eastern Asia Region – Reporting statistics

All indicators (66)

2010 2011 2012 2013 2014

Missing 20 (30%) 23 (35%) 23 (35%) 14 (21%) 6 (9%)


Estimates 20 (30%) 13 (20%) 21 (32%) 12 (18%) 3 (5%)

Table 26 shows a fairly substantial improvement in reporting from countries in the South Eastern

Asian region over the five year period. The percentage of missing indicators decreased from 30% to

9%, signifying an improvement in the quantity of data reported; additionally an improvement in

quality of reporting was reported through the reduction in identified inconsistencies. The

improvement in reporting has allowed for a reduction in the number of estimates calculated by

WHO from 30% to 5% between the years 2010 and 2014.

58

Western Pacific Region


Income Classification Group

Low Income Lower Middle

Income Upper Middle

Income High Income N/A Total

Total no. of countries 1 10 7 6 3 27

Of which are Gavi eligible 1 6 0 0 0 7

Table 27 – Western Pacific Region – Indicators summary

Indicators 2010 2011 2012 2013 2014





36% 40% 41% 52% 48%






40% 36% 43% 58% 43%



DTP3 Coverage:




Rotavirus 4 4 5 5 6

PCV 7 8 9 12 14

HPV 7 9 10 11 11

The 7 countries selected for analysis are listed on Table 28

By 2014, 25 of the 27 countries in the Western Pacific region had reported a line item in the national

budget for the procurement of vaccines. In 2011 Solomon Islands reported to having added the line

item to the national budget, but later reported no line item. In 2014 Japan began reporting to having

the line item in their national budget. The two countries in the region who did not report to having a

line item in 2014 were the Solomon Islands and Palau.

59

Figure 25 - Western Pacific Region - Government expenditure on RI

The aggregated government expenditure on routine immunization for the 7 selected countries in the

region, showed a positive overall trend over the period 2010 to 2014. The expenditures increased in

a fairly consistent manner initially at $314 million in 2010 rising to $340 million by 2012, after which

there was a slight dip in 2013 to $328 million before increasing to $345 million in 2014. The

magnitude and increasing trend in government expenditures on RI stems mainly from China, who

account for approximately $300 million of the aggregated expenditure in 2010 and even greater in

the subsequent years. Of the 7 countries included in the analysis, 6 reported an increase in

expenditures between the years 2010 and 2014, with only one (The Solomon Islands) reporting a

decreasing trend.

The percentage of routine immunization costs being funded by government increased across the

entire region, from 59% in 2010 to 71% in 2014. The government expenditure on RI and percentage

of government funding RI, displayed a fairly direct relationship which is to be expected.

36% 40% 41% 38%

48% 59%

65% 66% 71% 71%

$314 $331 $340 $328

$345

$0

$50

$100

$150

$200

$250

$300

$350

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding RI (average in 7 selected countries)Percentage of government funding RI (average % in all countries)Aggregated Expenditure in (7) selected countries (Millions US$)

60

Figure 26 - Western Pacific Region - Government expenditure on vaccines

The aggregated government expenditure on vaccines for 7 selected countries in the region increased

between the years 2010 and 2014, albeit with an inconsistent trend. The expenditure starts initially

at $277 million in 2010 before rising to $300 million in 2012, where the government expenditure on

vaccines peaks; the expenditure declines the following year (2013) to $291 million after which it

rises to $294 million in 2014. Once again this trend is driven mainly by China. 6 of the 7 included

countries reporting an increasing trend in government expenditure on vaccines between 2010 and

2014.

The percentage of vaccine expenditures funded by government also showed an increasing trend

over the 5 year period, across the entire region; overall there was an increase of 4 percentage points

from 69% to 73%.

These are extremely encouraging trends for the region, signalling movement towards greater

commitment and ownership of the immunization programs. 7 countries in the region are Gavi

eligible, with only one country in the Low income grouping (Cambodia) and the others in the higher

tier co-financing groups which helps in explaining the positive trends in government expenditure on

vaccines, and the proportion of vaccine costs being financed by government.

40% 36%

43% 44% 43%

69% 70% 73% 75% 73%

$277 $291 $300 $291 $294

$0

$50

$100

$150

$200

$250

$300

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding vaccines (average in 7 selected countries)Percentage of government funding vaccines (average % in all countries)Aggregated Expenditure in (7) selected countries (Millions US$)

61

Table 28 - Western Pacific Region - Government expenditure on RI per live birth


2010 2011 2012 2013 2014


2014

Percentage Change

Lao People's Democratic Republic (the) LMIC (Gavi) 1.8 1.6 1.4 1.5 26.7 Increasing 1367%

Cambodia LIC (Gavi) 7.5 8.3 7.3 6.3 26.0 Increasing 247%

Papa New Guinea LMIC (Gavi) 5.5 8.4 15.7 10.6 16.4 Increasing 195%

Marshall Islands UMIC 14.4 19.2 20.1 21.1 22.1 Increasing 54%

Vietnam LMIC (Gavi) 5.7 6.9 7.4 7.2 8.5 Increasing 49%

China UMIC 18.9 19.7 19.8 18.8 18.7 Decreasing -1%

Solomon Islands LMIC (Gavi) 61.7 61.6 72.4 46.3 20.1 Decreasing -67%




Table 28 shows the government expenditure on routine immunization per live birth for 7 selected

countries in the region. Five of the countries display an increasing trend between the years 2010 and

2014, whilst 2 show a decreasing trend. It is interesting to observe that China reported an increasing

trend in government expenditure on RI in absolute amounts, however when using the number of

live births as a denominator a decreasing trend emerges of 1 percentage point. The population

weighted average over this group of countries presents an irregular trend steered mainly by China,

which has a large weighting within the group of countries, The PWA increased over the years 2010 to

2012, from $17.3 to $18.3, after which it drops slightly to $17.4 the following year, before rising to

$18.0 in 2014.

62

Figure 27 - Western Pacific Region - Government expenditure on RI per live birth

Figure 27 shows the government expenditure on RI per live birth for the 7 selected countries in the

region, as well as the proportion which goes towards vaccine costs and service delivery. The

government expenditure on RI remains relatively stable over the 5 year period, as do the

government expenditures on vaccines per live birth. Stability in the trend of government

expenditure on RI and on vaccines allows for a steady trend in the proportion of these funds funding

vaccines - which remain constant at approximately 88% over the years 2010 to 2013 before dropping

to 85% in 2014.

88% 88% 88% 89% 85%

$17.3 $18.1 $18.3

$17.4 $18.0

0

2

4

6

8

10

12

14

16

18

20

2010 2011 2012 2013 2014

US$



63

Figure 28 - Western Pacific Region - Total expenditure on vaccines per live birth

Figure 28 shows the population weighted average of total expenditure on vaccines per live birth for

7 selected countries in the region. The proportion of total vaccine costs funded by government stays

extremely high and consistent throughout the 5 year period, remaining between 93 and 94%. This is

against the backdrop of relatively stable trend in total expenditures which is initially at $16.4 in 2010,

rising over the next 2 years to reach $17.3 after which it declines to $16.3 in 2013 before rising again

to $16.5. The externally funded expenditures on vaccines remain largely in unison with the

government expenditures so that stability in the proportion of total costs funded by government is

ensured.

93% 93% 94% 94% 93%

$16.4 $17.2 $17.3

$16.3 $16.5

0

2

4

6

8

10

12

14

16

18

20

2010 2011 2012 2013 2014

US$



64


Table 29 - Western Pacific Region – Reporting statistics


2010 2011 2012 2013 2014

Missing 52 (32%) 68 (42%) 57 (35%) 71 (44%) 67 (41%)


Estimates 38 (23%) 44 (27%) 28 (17%) 33 (20%) 14 (9%)

Table 29 shows a variable trend in the total number of indicators being reported over the five years

between 2010 and 2014, not showing any considerable improvements in this time. By 2014

percentage of indicators missing in the Western Pacific region was reported to be 41%, which is by

no means a small amount. In spite of the lack of improvements to the quantity of indicators reported,

the quality of reporting has increased with only 2 indicators identified as being inconsistent in 2014.

It must be said however that as the amount of indicators reported decreases, the amount of

indicators that can be found to be inconsistent decreases alongside it, and so caution should be

taken when interpreting these results.

65

Gavi Countries

73 Gavi eligible countries by income classification and Gavi Co-financing group:


Total no. of countries 34 36 3 0

73 Gavi Co-financing group (2016) Low Income Phase 1 Phase 2 Phase 3

Total no. of countries 31 21 16 5

Table 30 – Gavi countries – Indicators summary

Indicators 2010 2011 2012 2013 2014

No. of countries with line item in national budget for vaccines

65 66 66 69 66


% of total RI funded by government in all Gavi countries (average)

46% 42% 43% 42% 42%

% of total RI funded by government in (38) selected Gavi countries (average)

44% 39% 41% 45% 43%

Aggregated Expenditure in (38) selected Gavi countries (Millions US$)

236 237 242 245 259

Expenditure Per Live Birth in (38) selected Gavi countries (PWA US$)

10.1 10.0 10.0 9.9 10.4


% of total vaccines funded by government in all Gavi countries (average)

40% 33% 31% 34% 35%

% of total vaccines funded by government in (38) selected Gavi countries (average)

39% 32% 31% 36% 38%

Aggregated Expenditure in (38) selected Gavi countries (Millions US$)

115 101 101 107 113

Expenditure Per Live Birth in (38) selected Gavi countries (PWA US$)

6.8 6.8 6.7 6.3 6.0

The number of countries reporting a line item in their national budget for purchasing vaccines

increased in the group of Gavi eligible countries, from 65 in 2010 to 66 in 2014. In the intervening

period, a slightly irregular trend is seen as 2 countries (The Congo and Djibouti) report to adding a

line item in 2013, before reporting no line item in 2014 The Solomon Islands also reported no line

item in 2014. Whilst this may be a reflection of true events in these countries, it may be a result of

erroneous reporting.

66

Figure 29 - Gavi countries - Government expenditure on RI

Amongst the 38 Gavi countries9 with full time-series that were included in the analysis, an overall

increasing trend is seen in the government expenditure on routine immunization, from $236 million

to $259 million.

The percentage of government funding for routine immunization across all Gavi countries showed an

varying trend over the five-year period, however the magnitude of change between each of the

years was relatively small allowing the percentage of government funding to remain fairly stable

around 43%.

9 See Table 1

46% 42% 43%

42% 42%

44% 39% 41%

45% 43%

$236 $237 $242 $245 $259

$0

$50

$100

$150

$200

$250

$300

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding RI (Average % in all Gavi countries)

Percentage of government funding RI (Average % in 38 selected countries)

Aggregated Government Expenditure on RI (in 38 selected countries US$)

67

Figure 30 - Gavi countries - Government expenditure on vaccines

The amount of government expenditure on vaccines decreased over the period 2010-2014, albeit

very slightly and with an irregular trend during the intervening period. In 2010 the expenditure level

was calculated to be $115 million before sharply decreasing to $101 million in 2011, where the

expenditure level remained for a further year before increasing to $113 million by 2014. The initial

drop in expenditures comes as a result of a number of countries reporting a steep decline in

expenditures between the years 2010 and 2011; these countries include but are not limited to The

Democratic Republic of Congo, Nepal and Mali. The overall drop in the government expenditures can

be considered somewhat surprising, as it would be expected that an increase in expenditures would

occur as a result of the high number of new and underused vaccine introductions partnered with the

co-financing policy in place.

The percentage of government funding for vaccines decreased by 5 percentage points overall

between 2010 and 2015. During this time there was a consistent decrease between 2010 and 2013

from 40% to 31%, followed by a consistent increase over the next two years reaching to 35% in 2014.

The government expenditure and the percentage of government funding vaccines can be seen to

correspond well with each other, showing signs of a direct relationship which is to be expected.

40% 33%

31%

34%

35% 39%

32%

31%

36%

38%

$115

$101 $101 $107

$113

$0

$20

$40

$60

$80

$100

$120

$140

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014

(Mill

ion

s U

S$)


Percentage of government funding Vaccines (Average % in all Gavi countries)

Percentage of government funding Vaccines (Average % in 38 selectedcountries)Aggregated Government Expenditure on Vaccines (in 38 selected countries US$)

68

Table 31 - Government expenditure on RI per live birth by Gavi (2016) co-financing groupings

JRF Code Indicator 2010 2011 2012 2013 2014 Low Income (14 countries)

6540 Government Expenditure on

Routine Immunization 5.0 5.0 4.9 5.1 6.1


Vaccines 2.9 2.2 2.7 2.7 2.7

6520 Total Expenditure on Vaccines 16.1 16.4 16.2 21.9 23.8

Phase 1 (11 countries)




Vaccines 4.0 3.6 3.5 4.2 4.6


Phase 2&3 (13 countries)




Vaccines 13.9 14.7 13.8 12.0 10.8


Total Gavi (38 countries)




Vaccines 6.8 6.8 6.7 6.3 6.0


69

Table 31 presents the calculated expenditure per live birth data of Gavi eligible countries aggregated

by co-financing group, as well as the entire group of Gavi countries. Countries were only included in

the analysis if they exhibited a full time-series for each of the following JRF financing indicators:

Government Expenditure on Vaccines – JRF 6510

Total Expenditure on Vaccines – JRF 6520

Government Expenditure on Routine Immunization – JRF 6540

Gavi co-financing groups are based on the income of each country (assessed through GNI per capita),

with countries ascending through the different phases of support when certain income thresholds

are reached. The four groups are as follows:

Low-income “Initial self-financing” – Countries are only required to pay the minimum co-

financing amount of $0.20 per dose of any new or underused vaccine procured through

Gavi.

Phase 1 “Preparatory transition” – Countries are required to increase the total share of the

vaccine costs by 15% annually.

Phase 2 “Accelerated transition” – Once a country enters this phase, the share of vaccine

prices which the country pays is ramped up proportionally over 5 years until the country is

paying the full amount for each vaccine.

Phase 3 “Fully self-financing” – At this stage the country has graduated from Gavi support,

and is fully financing its own vaccine procurement. Countries will still have the ability to

procure vaccines through Gavi for a period of time, giving them access to the lower Gavi

prices.

It is clear that a key tenet of the co-financing policy is to ensure the financial sustainability of each

country’s immunization programme, with greater amounts of ownership and commitment being

instilled in the countries as they rise through the various phases of support.

At the time of writing, there are only 5 countries which have entered phase 3 of Gavi support and in

addition they have only recently entered this phase. Therefore the analysis groups together Gavi

countries in Phase 2 of support with countries in phase 3 of support.

Whilst co-financing arrangements are an integral aspect of the Gavi model, countries with harsh

fiscal constraints may still find that they unable to meet these requirements. If unable to pay the full

amount of the co-financing for a given year then the country is considered to be in default. Table 32

summarizes the distribution of countries, which defaulted on their co-financing at least once during

the five year period (2010-2014), by co-financing group.

Table 32 – Gavi countries – Distribution of defaulting countries

Distribution of defaulters (2010-2014) by co-financing group

Low Income Phase 1 Phase 2 Total

No. of countries 13 10 6 29

70

Figure 31 - Gavi countries (Low income group) – Total expenditure on vaccines per live birth

Figure 31 displays the proportion of vaccine expenditures (per live birth) funded by government over

the period 2010 to 2015 for the Low-income Gavi co-financing group. During the five years the total

expenditure on vaccines per live birth can be seen to increase over time from $16.1 in 2010 up to

$23.8 in 2014. The increase is relatively consistent over time, with the exception of 2011 to 2012,

where the expenditures dip very slightly from $16.4 to $16.2, before rising sharply to $21.9 in 2013.

Parallel to this, the government expenditures per live birth remain relatively constant at

approximately $2.7 throughout the five years, with only small variations. This leaves the overall

proportion of government funding for vaccines to decrease from 18% to 12% over time.

The proportion of expenditures funded may seem relatively low, but this is to be expected from this

group of countries. Whilst new vaccines are being introduced the total costs of vaccines are

escalating, however the majority of these countries are only paying the minimum co-financing

requirement of $0.20 per dose receiving the support from Gavi reducing the overall share funded by

government. Over time, it would be expected that the absolute amount of funding contributed by

government would increase in this group of countries; though this may not necessarily translate to

increases to the share paid by governments due to the mounting total costs of vaccines.

18% 14% 17% 12% 12%

$16.1 $16.4 $16.2

$21.9 $23.8

0

5

10

15

20

25

30

2010 2011 2012 2013 2014

US$

Low Income Group - Total Expenditure on Vaccines per live birth

Government Expenditure on Vaccines External Expenditure on Vaccines

71

Figure 32 - Gavi countries (Phase 1 group) - Total expenditure on vaccines per live birth

The analysis for the Gavi phase 1 group shows an extremely variable trend in total vaccine

expenditures over time, with a constant pattern of rising one year then falling somewhat by the next.

Overall, an increase can be seen over time with the total expenditure at $15.0 in 2010 rising to $20.7

by 2014, but actually peaking at $22.9 in 2013. Alongside this, the government expenditure on

vaccines also shows a slightly inconsistent trend, but increases overall from $4.0 in 2010 to $4.6 in

2014. The government expenditures dip slightly from 2010 to 2012, before increasing year-upon-

year. 10 countries in this group defaulted on their co-financing payment between the years 2010

and 2014 and so this may have contributed to the slightly irregular trend in government expenditure

on vaccines displayed.

The extremely erratic trend in total expenditures makes it difficult to assess any particular

progression in terms of proportion of government funding for vaccines. Overall a drop over the 5

years is apparent with 27% of vaccines funded by government in 2010, which decreased to 22% in

2014. Positive is the fact that overall government contributions have increased over time, but with

the abundance of support that this group receives for new vaccine introductions it is to be expected

that total costs have increased at a faster rate leaving the proportion funded by government to

decrease.

The analysis confirms the anticipated effect of the Phase 1 co-financing policy, with government

expenditures increasing in absolute terms. Comparing the Phase 1 and Low-income country groups it

can be seen that the proportion of vaccines funded by government is higher, implying a greater level

of financial ownership which is the anticipated effect of the co-financing arrangement.

27% 17% 19% 18% 22%

$15.0

$21.0

$17.9

$22.9 $20.7

0

5

10

15

20

25

2010 2011 2012 2013 2014

US$

Gavi Phase 1 Group - Total Expenditure on Vaccines per live birth


72

Figure 33 - Gavi countries (Phase 2 & 3 groups) - Total expenditure on vaccines per live birth

Figure 33 above shows the vaccine expenditure trends for the countries in the Phase 2 and 3 of Gavi

support. Surprisingly there are declining trends for both government as well as total expenditure on

vaccines, with both following the trend of showing an initial increase from 2010 to 2011, before

showing a consistent decrease over the following years. This trend is heavily influenced by the

reporting of Indonesia which was given considerable weighting when calculating the averages, given

that their population accounts for over half the total population of the group of countries included in

the calculation. However, this trend is not limited to Indonesia as 8 of the 13 countries included in

the analysis reported a decreasing trend in government expenditure on vaccines between 2010 and

2014, and 9 of the 13 countries reported a decreasing trend in total expenditure.

Alongside these changes in expenditures over the 5 year period, an overall drop in proportion of

vaccines funded by government is apparent, from 75% in 2010 to 72% in 2014. Between the years

2010 and 2014 there does exist slight variation, but it is worth noting that the increases and

decreases in government and total expenditure for this group remain largely proportional. Whilst

the trends may be decreasing, the overall proportion of government funding is relatively high in

comparison with the previous Gavi groups, which shows that the co-financing policy is partially

having its intended effect.

In order to remain consistent with the regional and global analysis the countries selected for analysis

needed a full time series for 3 financing indicators10. However to provide a fuller picture of this

group’s current trends Tables 33 and 34 display the government expenditure per live birth and total

expenditure per live birth of Gavi phase 2&3 countries which exhibit a full time-series for both

government expenditure and total expenditure on vaccines. This adds four additional countries in

comparison to the group of countries used in Figure 33.

10

Cfr Section on Country Selection Criteria

75% 69% 72% 74% 72%

$18.6

$21.3

$19.2

$16.3 $15.1

0

5

10

15

20

25

2010 2011 2012 2013 2014

US$

Gavi Phase 2&3 Group - Expenditure on Vaccines per live birth


73

Table 33 - Gavi Phase 2 & 3 countries - Government expenditure on vaccines per live birth (17 Countries with full time series)

Gavi Phase 2&3 countries - Government Expenditure on Vaccines Per Live Birth

2010 2011 2012 2013 2014

Bhutan 0.4 0.5 3.1 4.1 7.4

Angola* 3.5 4.4 13.6 15.1 18.3

Congo (The)* 2.3 1.1 2.8 4.2 9.9

Republic of Moldova 13.2 20.2 21.0 20.9 41.2

Mongolia 20.0 21.2 18.9 31.6 30.8

Vietnam* 3.4 4.1 4.4 4.4 5.1

Papa New Guinea 4.0 4.7 11.6 8.3 5.7

Bolivia* 31.1 27.9 30.5 33.6 40.2

Sri Lanka* 12.9 5.9 6.0 6.0 14.3

Honduras* 45.2 52.7 29.6 44.3 42.1

Nicaragua 51.3 22.5 23.9 41.1 46.1

Georgia* 33.1 12.6 14.9 38.2 27.6

Guyana* 64.8 66.0 62.5 50.4 50.7

Indonesia* 9.7 12.7 12.2 9.3 7.1

Timor-Leste* 10.7 8.8 3.9 5.7 7.4

Cuba* 180.5 173.4 149.2 105.3 106.7

Azerbaijan* 33.9 30.0 29.1 25.0 9.3

Countries selected for analysis are signified with an asterisk * - WHO estimates in italics

Countries are arranged in order of change in magnitude between 2010 and 2014

Table 34 - Gavi Phase 2 & 3 countries - Total expenditure on vaccines per live birth (17 Countries with full time series)

Gavi Phase 2&3 countries - Total Expenditure on Vaccines Per Live Birth

2010 2011 2012 2013 2014

Bhutan 7.1 11.4 21.9 18.1 24.0

Republic of Moldova 22.7 30.8 39.3 33.5 62.6

Angola* 12.1 12.9 13.6 27.4 28.3

Papa New Guinea 6.7 10.6 14.3 13.4 15.8

Congo (The)* 16.8 12.3 25.2 28.8 29.5

Mongolia 25.0 30.8 25.3 37.5 35.0

Bolivia* 31.1 27.9 40.6 33.6 43.4

Georgia* 41.7 16.2 25.8 61.9 43.3

Vietnam* 12.2 13.7 12.9 10.4 11.8

Indonesia* 9.7 12.7 12.2 11.0 9.1

Honduras* 71.6 68.5 65.5 70.3 57.6

Timor-Leste* 11.9 8.8 14.9 7.6 9.1

Sri Lanka* 22.7 15.2 14.9 14.7 15.2

Guyana* 94.4 121.4 110.1 82.7 61.9

Cuba* 182.8 174.4 150.7 106.4 107.3

Nicaragua 124.5 232.4 123.5 68.5 68.3

Azerbaijan* 43.4 38.5 33.1 28.8 21.3

Countries selected for analysis are signified with an asterisk * - WHO estimates in italics

Countries are arranged in order of change in magnitude between 2010 and 2014

74

Conclusion

By 2014 the majority of WHO member states had reported a specific line item in the national budget

for the purchasing of vaccines. 89% (173 countries) of all member states reported the inclusion of

the line item in 2014, which represents an increase from 2010 where 88% of all member states (170

countries) reported positively of the line item. Additionally by 2014, 90% of all Gavi eligible countries

had reported the inclusion of the line item. Whilst this can be interpreted fairly positively, in that

governments are showing greater commitment to the financing of immunization, it must be

remembered that the line item does not serve as a guarantee of greater budgetary allocations for

immunization.

The global analysis showed that governments increased their expenditure on vaccines over the five

year period, with the aggregated expenditure of 70 countries with full time-series showing an

increase from 1,535 million US$ in 2010 to 1,893 million US$ in 2014. During this time however,

donor funds for vaccines increased at a faster rate meaning that the percentage of total vaccine

costs funded by government decreased from 73% in 2010 to 70% in 2014.

The analysis also showed that on average, governments channelled approximately 87% of their

domestic routine immunization expenditures towards vaccine costs, which leads to similar trends

appearing when viewing the government expenditures on routine immunization. When the

aggregated government expenditure on routine immunization is calculated over the same 70

countries with a full time series, there is an increase from 1,759 million US$ in 2010, to 2,164 million

in 2014. Given the fact that routine immunization also captures vaccines, the growth in donor

support for vaccine costs has caused the proportion of total routine immunization costs funded by

government, which fell from 75% in 2010 to 73% in 2014.

The results of the global analysis indicate that financial commitment to immunization is increasing,

as signified by the increasing domestic funds that governments are allocating for the use of

immunization. In spite of this Gavi and other donor support is growing at such a rate that is

drowning out the proportion of government funding for immunization and thus limiting the overall

financial ownership of countries.

The regional analysis showed the large disparity which exists between relatively richer and poorer

regions, with the countries in the European region and the region of the Americas have shown

themselves to be the most self-sufficient in supporting their own immunization costs, with over 90%

of total routine immunization costs being funded by government on average, in both regions. The

African region is the most reliant on donor support having only funded 50% of total RI costs with

domestic funds in 2010, and decreasing over time to 40% in 2014.

The data reported not only shows variability in expenditures between regions but also within regions.

A striking example of can be seen in the Region of the Americas when looking Haiti’s total

expenditure on vaccines per live birth in 2014 which corresponds to only 0.02% of Argentina’s

expenditures for the same year. In this case, the large scale disparity exists mainly due to the

difference in income between the two countries, but there may be other reasons for why intra-

regional variability exists. A country’s immunization schedule may have the largest impact on the

cost of immunization; countries which are classified as high income have greater resources for the

75

addition of new and expensive vaccines into the schedule. Countries with lower relative income may

still be hesitant when introducing these vaccines into their schedule, even with the support of Gavi.

Additionally, the organization of an immunization programme within a country can lead to efficiency

gains through shared resources depending on the extent to which immunization is integrated with

other health interventions; when this occurs the costs related to immunization may be distributed

across other areas of the health sector.

The prices of vaccines are of particular importance for high income countries as well as middle

income countries which are not Gavi eligible. Countries which do not have access to Gavi prices are

subject to much higher prices for vaccines, creating problems when middle income countries are

ineligible for Gavi support but do not yet have the fiscal space needed to support vaccine

introductions. Establishing greater price transparency can help provide countries with a better

platform to procure from pharmaceutical companies, and this is one of the main aims of the WHO

Vaccine Product, Price and Procurement (V3P)11 project. It is hoped that this data will be used in the

future to aid the interpretation of expenditure data for high and middle income countries.

The analysis also found that within Gavi eligible countries the policy of co-financing is having its

intended effect only partially realised. Countries with a relatively higher income are paying a greater

share towards their immunization costs; however the total share of vaccine costs being paid by

government is decreasing over time. Whilst this is somewhat expected of the countries in the Low

income co-financing group, the Phase 2 & 3 countries are expected to be displaying greater

movements towards self-sufficiency.

The quality of previously reported data remains an impediment to the interpretation of these

analyses. A number of countries fail to fully report the JRF financing indicators, and in some cases

errors and inconsistencies apparent in the data that is reported. The JRF financing indicators

guidance note 201512 has helped countries with greater understanding of the JRF indicators and

methods for reporting.. Additionally feedback for country reporting has been intensified with a full-

time series of reported indicators presented to each country with potential inconsistencies

highlighted, so that greater emphasis is placed on the revision of erroneously reported data.

The JRF financing indicators remains the most comprehensive source of officially reported

immunization financing data. Whilst not all countries report fully each year, the majority of the 194

member states have contributed data via the JRF mechanism, over the past few years. Not only is

the database of immunization financing data growing but the quality is improving. Data for the year

2014 saw an improvement in reporting in comparison to previous years, as well as a reduction in the

number of WHO estimates calculated in place of missing or inconsistent data. Progression in quality

and reporting are essential for the JRF financing indicators, and with the global initiatives currently

being developed it is hoped that progress with the financing indicators will come in the near future.

11

http://www.who.int/immunization/programmes_systems/procurement/v3p/en/ 12

http://www.who.int/immunization/programmes_systems/financing/data_indicators/JRF_guidance_note.pdf

76

Annexes

Annex 1 - African Region Tables

AFR - Government expenditure on routine immunization (JRF 6540)


Gavi grouping

2010 2011 2012 2013 2014

Algeria UMIC

41,680,180

Angola UMIC⁺ Phase 2 5,450,000

Benin* LIC⁺ Low Income 2,339,540 1,972,534 2,044,319 2,116,104 2,114,499

Botswana UMIC

836,081 1,731,266

3,520,754

Bukina Faso* LIC⁺ Low Income 3,822,460 4,025,805 3,601,759 3,177,712 3,527,388

Burundi LIC⁺ Low Income 289,431 324,910

575,041 796,850

Cameroon* LMIC⁺ Phase 1 5,385,915 6,307,563 2,850,283 4,415,102 4,947,261

Cabo Verde LMIC

Central African Republic*

LIC⁺ Low Income 80,763 166,453 65,477 137,497 158,152

Chad* LIC⁺ Low Income 3,936,645 369,710 3,621,316 3,068,877 2,091,084

Comoros* LIC⁺ Low Income 400,000 310,317 220,634 107,195 52,632

Congo (The)* LMIC⁺ Phase 2 492,654 768,239 1,516,930 1,705,019 2,556,926

Côte d'Ivoire* LMIC⁺ Phase 1 5,501,268 3,727,561 10,413,080 9,087,070 6,220,967

Democratic Republic of the Congo*

LIC⁺ Low Income 1,849,497 1,828,000 4,469,057 4,999,802 3,845,799

Equatorial Guinea HIC

37,148 62,471

195,019

Eritrea* LIC⁺ Low Income 119,454 435,894 448,971 462,440 462,440

Ethiopia LIC⁺ Low Income 41,922,284

5,530,069

36,333,665

Gabon* UMIC

3,162,230 1,500,424 1,619,893 1,673,954 1,322,000

Gambia LIC⁺ Low Income

705,000 762,500 820,000

Ghana LMIC⁺ Phase 1

5,055,561 5,234,535 5,335,036

Guinea LIC⁺ Low Income 328,881 782,800 704,500

Guinea-Bissau LIC⁺ Low Income

131,174

0

Kenya LIC⁺ Phase 1 6,263,408 6,463,301 6,101,297 5,739,293 5,311,200

Lesotho LMIC⁺ Phase 1

205,122

Liberia LIC⁺ Low Income

406,012 265,591

Madagascar LIC⁺ Low Income 413,955 911,352 1,329,337 2,126,347

Malawi LIC⁺ Low Income 3,409,336 3,277,986

1,345,500 1,651,330

Mali* LIC⁺ Low Income 6,723,648 6,723,648 2,193,072 3,837,632 5,482,191

Mauritania* LMIC⁺ Phase 1 815,980 493,770 416,428 412,277 3,556,218

Mauritius UMIC

708,800

Mozambique LIC⁺ Low Income 3,678,367 4,205,882 4,771,068 6,130,857

Namibia UMIC

1,798,066

2,991,106

Niger LIC⁺ Low Income 1,345,618

Nigeria LMIC⁺ Phase 1 24,218,552

49,205,698

Rwanda* LIC⁺ Low Income 2,144,812 2,327,804 2,510,796 2,564,291 2,463,874

Sao Tome and Principe*

LMIC⁺ Phase 1 453,710 408,456 642,764 770,154 593,496

77

Country* Income Status⁺

Gavi grouping

2010 2011 2012 2013 2014

Senegal LMIC⁺ Phase 1

7,980,174 2,893,668 1,608,692

Seychelles UMIC

47,781 35,982 75,971

369,338

Sierra Leone LIC⁺ Low Income

783,674 621,791 459,907 1,395,039

South Africa UMIC

142,835,153

South Sudan LMIC⁺ Low Income

450,000

Swaziland* LMIC

1,989,668 2,526,005 2,171,223 2,065,204 1,836,215

Tanzania* LIC⁺ Low Income 8,136,762 10,366,355 5,934,559 5,565,920 15,443,664

Togo* LIC⁺ Low Income 4,347,640 4,756,485 5,610,776 5,352,552 920,000

Uganda LIC⁺ Low Income 2,924,088

4,987,097 16,150,943

Zambia LMIC⁺ Phase 1 15,471,172 23,884,005 24,586,672 25,289,340

Zimbabwe LIC⁺ Low Income

15,337,620 16,062,460 9,000,000 13,303,147

Countries included in the analysis are marked with an asterisk*

Gavi eligible countries are signified with a plus ⁺ over the income status


AFR - Percentage of government expenditure on routine immunization funded by

government (JRF 6560)


Gavi grouping

2010 2011 2012 2013 2014

Algeria UMIC

100 100 100 100 100

Angola UMIC⁺ Phase 2 34 90 90 88

Benin* LIC⁺ Low Income 35 17 23 33 33

Botswana UMIC

92 98

100 97

Bukina Faso* LIC⁺ Low Income 34 33 27 22 9

Burundi LIC⁺ Low Income 6

5 8

Cameroon* LMIC⁺ Phase 1 18 24 13 16 21

Cabo Verde LMIC

100 100 100 100 100


LIC⁺ Low Income 4 3 1 5 2

Chad* LIC⁺ Low Income 94 11 43 35 54

Comoros* LIC⁺ Low Income 32 31 30 16 8

Congo (The)* LMIC⁺ Phase 2 17 30 28 24 40

Côte d'Ivoire* LMIC⁺ Phase 1 53 35 92 83 10




59 93 100 80 100

Eritrea* LIC⁺ Low Income 5 30 26 30 22

Ethiopia LIC⁺ Low Income 51

8

33

Gabon* UMIC

98 94 94 95 98

Gambia LIC⁺ Low Income

10 31 33 35


13 16 19

Guinea LIC⁺ Low Income

19 13


Kenya LIC⁺ Phase 1 85 88

15 14

78


Gavi grouping

2010 2011 2012 2013 2014


47

54

Liberia LIC⁺ Low Income

6 6

Madagascar LIC⁺ Low Income 5 11 7 6

Malawi LIC⁺ Low Income 32

5 10

Mali* LIC⁺ Low Income 22 22 7 15 17

Mauritania* LMIC⁺ Phase 1 33 37 24 9 41

Mauritius UMIC

100 100

Mozambique LIC⁺ Low Income 25 24 34 23

Namibia UMIC

100 100

Niger LIC⁺ Low Income 13 51

Nigeria LMIC⁺ Phase 1 89

24

Rwanda* LIC⁺ Low Income 29 17 12 16 11


LMIC⁺ Phase 1 83 84 75 89 77

Senegal LMIC⁺ Phase 1 100 20 30 15 8

Seychelles UMIC

100 48 60

97

Sierra Leone LIC⁺ Low Income

22

9 22

South Africa UMIC

100 100 100 100 100


5 1

Swaziland* LMIC

90 90 90 97 97

Tanzania* LIC⁺ Low Income 19 18 22 8 21

Togo* LIC⁺ Low Income 46 45 51 55 25

Uganda LIC⁺ Low Income 21

24 49

Zambia LMIC⁺ Phase 1 66 69 69 69

Zimbabwe LIC⁺ Low Income 3 68 89 36 30




AFR - Government expenditure on vaccines (JRF 6510)


Gavi grouping

2010 2011 2012 2013 2014

Algeria UMIC

15,345,431 33,852,740 41,680,180

Angola UMIC⁺ Phase 2 3,150,000 4,122,907 12,932,000 14,643,880 18,093,035


Botswana UMIC

459,886 1,672,771

3,444,284


Burundi LIC⁺ Low Income 289,431 324,910 775,136 451,862 657,548


Cabo Verde LMIC

323,491 250,890 216,368 181,846 185,350


LIC⁺ Low Income 80,763 23,605 55,500 64,772 155,065

79


Gavi grouping

2010 2011 2012 2013 2014

Chad* LIC⁺ Low Income 2,096,818 369,710 1,513,521 1,688,122 1,720,848


Congo (The)* LMIC⁺ Phase 2 327,090 159,901 419,701 648,740 1,562,395

Côte d'Ivoire* LMIC⁺ Phase 1 3,891,764 1,888,823 829,125 5,388,211 3,581,818


LIC⁺ Low Income 1,625,242 695,881 4,466,399 3,727,193 2,628,012


37,148 62,471

169,607 195,019

Eritrea* LIC⁺ Low Income 26,771 32,000 32,960 46,000 87,025

Ethiopia LIC⁺ Low Income 1,070,729 7,000,000 5,530,069

8,499,761

Gabon* UMIC

989,346 1,500,424 1,482,780 1,532,265 774,671

Gambia LIC⁺ Low Income 260,000 220,000 265,000 333,727 600,300


3,555,615 3,059,333 2,553,075

Guinea LIC⁺ Low Income 284,038 187,500 180,750 174,000 295,548


32,500 0 0 0

Kenya LIC⁺ Phase 1 3,500,750 4,500,250 4,388,694 4,277,138 5,133,400


255,212

204,232 112,280

Liberia LIC⁺ Low Income 121,980 155,623 158,236 120,132 232,500

Madagascar LIC⁺ Low Income 381,163 874,747 629,813 1,907,315 337,615

Malawi LIC⁺ Low Income 3,321,852 2,705,947 1,902,974 1,100,000 1,028,616


Mauritania* LMIC⁺ Phase 1 211,219 267,290 189,980 365,610 518,833

Mauritius UMIC

584,712 1,428,273 708,800 377,818 947,047


Namibia UMIC

1,798,066 2,394,586 2,991,106 1,936,946

Niger LIC⁺ Low Income 1,272,016 1,181,247 1,468,508 1,755,769 1,775,465


7 40,629,508 37,227,051



LMIC⁺ Phase 1 4,432 10,249 16,652 10,500 14,468

Senegal LMIC⁺ Phase 1 1,543,437 1,412,352 1,018,136 2,012,336 1,608,692

Seychelles UMIC

47,781 31,397 75,971 149,405 266,310

Sierra Leone LIC⁺ Low Income 72,250 89,500 205,750 322,000 360,000

South Africa UMIC

142,835,153

168,399,924 123,435,192 122,117,591 136,849,813


0 0

Swaziland* LMIC

894,796 1,352,814 1,207,454 1,207,967 1,247,653


Togo* LIC⁺ Low Income 216,680 844,000 845,000 1,063,830 920,000

Uganda LIC⁺ Low Income 1,639,048 2,860,099

3,006,424 4,337,739

Zambia LMIC⁺ Phase 1 1,330,091 2,297,507 2,365,100 2,432,692 1,507,620

Zimbabwe LIC⁺ Low Income 0 0

624,500 882,500




80

AFR – Total expenditure on vaccines (JRF 6520)


Gavi grouping

2010 2011 2012 2013 2014

Algeria UMIC

15,345,431 33,852,740 41,680,180

Angola UMIC⁺ Phase 2 10,993,500 11,962,750 12,932,000 26,613,380 28,071,035


Botswana UMIC

459,886 1,672,771

3,444,284


Burundi LIC⁺ Low Income 3,328,353 11,410,685 11,517,715 9,773,702 9,072,982


Cabo Verde LMIC

323,491 250,890 216,368 181,846 185,350


LIC⁺ Low Income 2,242,833 2,363,942 2,296,330 2,640,268 3,495,031

Chad* LIC⁺ Low Income 3,225,874 3,351,252 6,260,482 4,152,498 1,764,724


Congo (The)* LMIC⁺ Phase 2 2,432,500 1,834,192 3,837,735 4,467,308 4,656,455

Côte d'Ivoire* LMIC⁺ Phase 1 7,115,064 6,304,025 3,134,085 8,982,291 22,159,318


LIC⁺ Low Income 43,442,646 43,442,646 42,252,617 53,946,231 59,020,935


62,471 67,094

169,607 195,019

Eritrea* LIC⁺ Low Income 1,866,054 1,227,950 1,264,789 1,086,040 1,420,000

Ethiopia LIC⁺ Low Income 20,037,006 95,068,972 66,159,005

72,954,162

Gabon* UMIC

989,346 1,500,424 1,482,780 1,532,265 774,671

Gambia LIC⁺ Low Income 538,571 220,000 1,665,000 1,720,315 1,775,629


33,265,939 20,059,450 22,091,850

Guinea LIC⁺ Low Income 1,205,779 784,109 705,698 420,000


142,843

Kenya LIC⁺ Phase 1 7,250,750 7,850,700

27,727,538 34,220,900


612,657

379,856 1,168,422

Liberia LIC⁺ Low Income 2,132,880 1,714,317 1,881,164 2,564,374 4,329,252

Madagascar LIC⁺ Low Income 8,155,704 4,214,790 14,865,200 29,839,815 19,462,461

Malawi LIC⁺ Low Income 9,224,949 7,496,685 7,496,685 15,714,286 14,694,514


Mauritania* LMIC⁺ Phase 1 1,936,363 1,267,385 1,263,922 2,235,017 4,879,429

Mauritius UMIC

584,712 1,428,273 708,800 377,818 947,047


Namibia UMIC

1,798,066 2,394,586 6,645,186 1,936,946

Niger LIC⁺ Low Income 9,112,478 8,398,500 6,536,500 4,674,500 4,022,431


73,764,508 90,962,051



LMIC⁺ Phase 1 72,225 70,162 214,962 187,481 186,823

Senegal LMIC⁺ Phase 1 1,543,437 4,440,693 3,808,483 7,547,336 19,525,290

Seychelles UMIC

47,781 31,397 127,568 314,797 266,310

Sierra Leone LIC⁺ Low Income 4,055,291 3,610,500 4,297,886 4,985,272 5,070,999

81


Gavi grouping

2010 2011 2012 2013 2014

South Africa UMIC

142,835,153

168,399,924

123,435,192

122,117,591

136,849,813


1,252,594 1,345,670

Swaziland* LMIC

894,796 1,352,814 1,207,454 1,403,244 1,247,653


Togo* LIC⁺ Low Income 2,722,634 3,431,629 3,431,629 2,523,752 3,092,880

Uganda LIC⁺ Low Income 4,575,450 15,096,699

18,949,424 29,851,928

Zambia LMIC⁺ Phase 1 6,857,695 7,939,344 8,172,919 8,406,495 11,948,620

Zimbabwe LIC⁺ Low Income 1,366,516 5,134,846 6,553,110 12,075,100 15,469,622




AFR – Percentage of government expenditure on vaccines funded by government (JRF

6530)


Gavi grouping

2010 2011 2012 2013 2014

Algeria UMIC

100 100 100 100 100

Angola UMIC⁺ Phase 2 29 34 100 55 64

Benin* LIC⁺ Low Income 18 17 17 32 32

Botswana UMIC

100 100

100 100

Bukina Faso* LIC⁺ Low Income 33 32 39 22 11

Burundi LIC⁺ Low Income 9 3 7 5 7

Cameroon* LMIC⁺ Phase 1 96 9 13 12 15

Cabo Verde LMIC

100 100 100 100 100



Chad* LIC⁺ Low Income 65 11 24 41 98

Comoros* LIC⁺ Low Income 6 7 8 7 8

Congo (The)* LMIC⁺ Phase 2 13 9 11 15 34

Côte d'Ivoire* LMIC⁺ Phase 1 55 30 26 60 16




59 93 100 100 100

Eritrea* LIC⁺ Low Income 1 3 3 4 6

Ethiopia LIC⁺ Low Income 5 7 8

12

Gabon* UMIC

100 100 100 100 100

Gambia LIC⁺ Low Income 48 100 16 19 34


11 15 12

Guinea LIC⁺ Low Income 24 24 26 41


23

0

Kenya LIC⁺ Phase 1 48 57

15 15


42

54 10

82


Gavi grouping

2010 2011 2012 2013 2014

Liberia LIC⁺ Low Income 6 9 8 5 5

Madagascar LIC⁺ Low Income 5 21 4 6 2

Malawi LIC⁺ Low Income 36 36 25 7 7

Mali* LIC⁺ Low Income 20 17 12 14 24

Mauritania* LMIC⁺ Phase 1 11 21 15 16 11

Mauritius UMIC

100 100 100 100 100

Mozambique LIC⁺ Low Income 27 20 30 20

Namibia UMIC

100 100 45 100 50

Niger LIC⁺ Low Income 14 14 22 38 44

Nigeria LMIC⁺ Phase 1 71

55 41

Rwanda* LIC⁺ Low Income 25 11 8 13 10


LMIC⁺ Phase 1 6 15 8 6 8

Senegal LMIC⁺ Phase 1 100 32 27 27 11

Seychelles UMIC

100 100 60 47 100

Sierra Leone LIC⁺ Low Income 2 2 5 6 7

South Africa UMIC

100 100 100 100 100


0 0

Swaziland* LMIC

100 100 100 86 100

Tanzania* LIC⁺ Low Income 18 23 25 7 6

Togo* LIC⁺ Low Income 8 25 25 42 30

Uganda LIC⁺ Low Income 36 19

16 15

Zambia LMIC⁺ Phase 1 19 29 29 29 13

Zimbabwe LIC⁺ Low Income 0 0

5 6




83

Annex 2 – Region of the Americas Tables

AMR – Government expenditure on routine immunization (JRF 6540)


Gavi grouping

2010 2011 2012 2013 2014

Antigua and Barbuda HIC

13,006

Argentina* UMIC

55,980,481 190,838,603 157,480,887 116,843,954 184,126,563

Bahamas* HIC

725,000 600,000 751,129 715,849 938,603

Barbados HIC

502,000 1,000,000 332,489

394,000

Belize* UMIC

417,821 515,750 293,535 326,113 385,735

Bolivia* LMIC⁺ Phase 2 12,212,571 12,588,827 11,543,982 10,159,889 15,107,807

Brazil* UMIC

665,531,259 554,584,798 484,145,091 579,374,984 847,606,242

Canada HIC

Chile HIC

50,131,331 57,005,158 63,878,986 30,843,797

Colombia* UMIC

58,818,257 100,229,518 92,691,277 114,084,578 99,857,080

Costa Rica UMIC

34,819,273 6,004,595 10,974,990 12,184,329

Cuba* UMIC⁺ Phase 2 22,308,824 21,198,121 18,538,221 15,261,695 26,102,700

Dominica* UMIC

16,048 54,243 59,558 52,501 45,444

Dominican Republic* UMIC

3,093,353 4,283,654 5,981,476 17,997,762 8,075,918

Ecuador UMIC

50,117,582 52,992,554 48,127,535 31,679,053

El Salvador* LMIC

12,542,732 14,987,726 10,080,587 11,255,896 9,987,957

Grenada* UMIC

108,337 78,041 115,944 75,146 96,912

Guatemala* LMIC

12,951,873 13,318,520 30,147,977 22,350,347 26,361,628

Guyana* LMIC⁺ Phase 2 1,173,124 874,018 1,545,402 1,920,720 1,890,980

Haiti LIC⁺ Low

Income

Honduras* LMIC⁺ Phase 3 10,200,787 12,195,240 8,357,269 9,498,744 10,680,410

Jamaica* UMIC

9,057,376 3,433,665 3,483,142 3,418,468 1,617,847

Mexico UMIC

485,693,607

346,061,159

Nicaragua* LMIC⁺ Phase 2 10,864,144 8,132,275 8,294,421 10,487,590 11,044,478

Panama* UMIC

18,475,976 26,623,319 23,849,045 25,907,927 25,680,824

Paraguay* LMIC

8,112,137 18,675,228 34,007,777 24,891,934 15,776,092

Peru* UMIC

135,200,521 90,038,062 122,258,207 59,908,061 70,882,598

Saint Kitts and Nevis* HIC

27,392 21,790 23,662 28,875 24,675

Saint Lucia* UMIC

77,464 55,616 83,847 112,079 75,088

Saint Vincent and The Grenadines*

UMIC

48,917 32,226 40,418 43,524 64,922

Suriname UMIC

1,173,000 1,152,000

334,811

Trinidad and Tobago HIC

2,164,742 2,601,000 2,065,287

United States of America

HIC

Uruguay* HIC

7,461,751 8,539,306 8,232,939 7,926,572 10,095,812

Venezuela* UMIC

30,977,753 46,141,844 48,081,194 43,684,961 52,108,065

Countries included in the analysis are marked with an asterisk* - WHO estimates in italics


84

AMR – Percentage of government expenditure on routine immunization funded by



Gavi grouping

2010 2011 2012 2013 2014

Antigua and Barbuda HIC 93

Argentina* UMIC 100 100 100 60 77

Bahamas* HIC 100 100 100 100 99

Barbados HIC 100 98 99

Belize* UMIC 97 91 95 98 99

Bolivia* LMIC⁺ Phase 2 85 100 80 99 95

Brazil* UMIC 100 100 100 100 100

Canada HIC

Chile HIC 100 100 100 100

Colombia* UMIC 100 100 100 100 100

Costa Rica UMIC 100 98 100 100

Cuba* UMIC⁺ Phase 2 98 99 99 99 100

Dominica* UMIC 100 96 92 90 88

Dominican Republic* UMIC 100 45 99 99 94

Ecuador UMIC 100 100 100 100

El Salvador* LMIC 100 99 99 100 100

Grenada* UMIC 98 98 95 92 92

Guatemala* LMIC 100 100 99 100 99

Guyana* LMIC⁺ Phase 2 73 56 71 79 91

Haiti LIC⁺

Low Income

Honduras* LMIC⁺ Phase 3 66 83 60 67 80

Jamaica* UMIC 99 97 99 100 99

Mexico UMIC 100 100 100 100

Nicaragua* LMIC⁺ Phase 2 52 23 39 74 75

Panama* UMIC 99 99 100 99 99

Paraguay* LMIC 94 97 99 100 100

Peru* UMIC 98 100 100 100 100

Saint Kitts and Nevis* HIC 100 100 100 100 95

Saint Lucia* UMIC 100 100 93 99 91

Saint Vincent and The Grenadines* UMIC

100 100 100 100 94

Suriname UMIC 84 97 100 100 98

Trinidad and Tobago HIC 100 100 100 95 100

United States of America HIC

Uruguay* HIC 100 100 100 100 100

Venezuela* UMIC 100 99 100 100 100




85

AMR – Government expenditure on vaccines (JRF 6510)


Gavi grouping

2010 2011 2012 2013 2014


Argentina* UMIC

53,853,728 181,213,432 155,137,242 111,139,854 164,284,599

Bahamas* HIC

431,663 600,000 743,440 677,632 913,430

Barbados HIC

500,000 1,000,000

390,000

Belize* UMIC

324,727 453,702 248,329 280,816 228,747


Brazil* UMIC

646,287,755 554,584,798 477,470,703 562,777,141 837,539,135

Canada HIC

Chile HIC

46,637,384 54,469,680 62,301,976 28,635,521

Colombia* UMIC

52,123,331 90,765,128 80,216,368 100,852,017 86,202,456

Costa Rica UMIC

22,839,273 6,000,395 8,574,990 10,683,329

Cuba* UMIC⁺ Phase 2 21,429,787 20,522,332 17,663,421 12,479,300 12,605,300

Dominica* UMIC

16,048 54,243 53,558 23,519 42,477


2,971,280 4,113,784 5,760,261 17,736,962 7,841,106

Ecuador UMIC

47,692,647 44,000,000 40,078,302 30,874,909

El Salvador* LMIC

12,269,249 14,987,726 9,951,285 11,023,085 9,820,720

Grenada* UMIC

81,436 41,751 76,911 51,390 55,326

Guatemala* LMIC

12,404,935 12,924,114 20,665,402 20,176,191 25,918,263

Guyana* LMIC⁺ Phase 2 687,240 749,900 793,495 721,427 798,216

Haiti LIC⁺ Low

Income 0


Jamaica* UMIC

965,116 1,156,060 1,018,208 1,363,098 677,253

Mexico UMIC

236,303,516

251,000,000


Panama* UMIC

17,126,920 26,165,359 17,133,140 23,996,790 24,122,318

Paraguay* LMIC

6,246,007 12,334,295 30,231,454 22,168,219 14,104,984

Peru* UMIC

103,839,740 61,995,144 86,342,459 59,908,061 54,474,855


27,392 21,370 20,962 28,875 23,675

Saint Lucia* UMIC

67,434 55,616 63,356 71,096 38,221


UMIC

43,761 27,894 39,627 43,524 64,922

Suriname UMIC

600,000 600,000 254,545 1,214,006 302,192


2,154,742

2,019,768


HIC

Uruguay* HIC

7,422,761 7,568,940 7,717,813 7,866,687 10,047,746

Venezuela* UMIC

29,180,899 38,622,525 46,239,711 35,471,747 48,247,862




86

AMR – Total expenditure on vaccines (JRF 6530)


Gavi grouping

2010 2011 2012 2013 2014

Antigua and Barbuda HIC 13,006

Argentina* UMIC 53,853,728 181,213,432 155,137,242 189,844,036 218,837,799

Bahamas* HIC 431,663 600,000 743,440 677,632 913,430

Barbados HIC 500,000 1,020,000 390,000

Belize* UMIC 324,727 453,702 248,329 280,816 228,747


Brazil* UMIC 646,287,755 554,584,798 477,470,703 562,777,141 837,539,135

Canada HIC

Chile HIC 46,637,384 54,469,680 62,301,976 28,635,521

Colombia* UMIC 52,123,331 90,765,128 80,216,368 100,852,017 86,202,456

Costa Rica UMIC 22,839,273 6,000,654 8,574,990 10,683,329

Cuba* UMIC⁺ Phase 2 21,706,941 20,639,220 17,841,840 12,605,300 12,677,050

Dominica* UMIC 16,048 54,243 53,558 23,519 51,548

Dominican Republic* UMIC 2,971,280 8,286,606 5,760,261 17,736,962 8,307,899

Ecuador UMIC 47,692,647 44,000,000 40,078,302 30,874,909

El Salvador* LMIC 12,269,249 14,987,726 9,951,285 11,023,085 9,820,720

Grenada* UMIC 81,436 41,751 76,911 51,390 55,326

Guatemala* LMIC 12,404,935 12,924,114 20,665,402 20,176,191 25,918,263

Guyana* LMIC⁺ Phase 2 1,001,379 1,378,178 1,397,904 1,183,349 974,074

Haiti LIC⁺

Low Income

382,737 183,819 111,164 175,824


Jamaica* UMIC 965,116 1,156,060 1,018,208 1,363,098 677,253

Mexico UMIC 236,303,516 251,000,000


Panama* UMIC 17,126,920 26,165,359 17,133,140 23,996,790 24,122,318

Paraguay* LMIC 6,246,007 12,334,295 30,231,454 22,168,219 14,104,984

Peru* UMIC 103,839,740 61,995,144 86,342,459 59,908,061 54,474,855

Saint Kitts and Nevis* HIC 27,392 21,370 20,962 28,875 23,675

Saint Lucia* UMIC 67,434 55,616 63,356 111,782 38,221

Saint Vincent and The Grenadines* UMIC

43,761 27,894 39,630 43,524 69,384

Suriname UMIC 600,000 600,000 254,545 1,214,006 302,192

Trinidad and Tobago HIC 2,154,742 2,019,768

United States of America HIC

Uruguay* HIC 7,422,761 7,568,940 7,717,813 7,866,687 10,047,746

Venezuela* UMIC 29,180,899 38,622,525 46,239,711 35,471,747 48,247,862




87

AMR – Percentage of vaccine expenditures funded by government (JRF 6530)


Gavi grouping

2010 2011 2012 2013 2014


100

Argentina* UMIC

100 100 100 59 75

Bahamas* HIC

100 100 100 100 100

Barbados HIC

100 98

100

Belize* UMIC

100 100 100 100 100

Bolivia* LMIC⁺ Phase 2 100 100 75 100 93

Brazil* UMIC

100 100 100 100 100

Canada HIC

Chile HIC

100 100 100 100

Colombia* UMIC

100 100 100 100 100

Costa Rica UMIC

100 100 100 100

Cuba* UMIC⁺ Phase 2 99 99 99 99 99

Dominica* UMIC

100 100 100 100 82


100 50 100 100 94

Ecuador UMIC

100 100 100 100

El Salvador* LMIC

100 100 100 100 100

Grenada* UMIC

100 100 100 100 100

Guatemala* LMIC

100 100 100 100 100

Guyana* LMIC⁺ Phase 2 69 54 57 61 82

Haiti LIC⁺ Low

Income 0 0

Honduras* LMIC⁺ Phase 3 63 77 45 63 73

Jamaica* UMIC

100 100 100 100 100

Mexico UMIC

100 100 100

100

Nicaragua* LMIC⁺ Phase 2 41 10 19 60 67

Panama* UMIC

100 100 100 100 100

Paraguay* LMIC

100 100 100 100 100

Peru* UMIC

100 100 100 100 100


100 100 100 100 100

Saint Lucia* UMIC

100 100 100 64 100


UMIC

100 100 100 100 100

Suriname UMIC

100 100 100 100 100


100 100 100 100 100


HIC

Uruguay* HIC

100 100 100 100 100

Venezuela* UMIC

100 100 100 100 100




88

Annex 3 – Eastern Mediterranean Region Tables

EMR – Government expenditure on routine immunization (JRF 6540)


Gavi grouping

2010 2011 2012 2013 2014

Afghanistan LIC⁺ Low

Income 2,358,530 2,485,900 2,730,558 1,239,297

Bahrain HIC

Djibouti* LMIC⁺ Phase 1 805,165 694,910 1,426,598 1,624,519 1,725,735

Egypt LMIC

55,594,865

Iran* UMIC

17,000,000 17,000,000 25,000,000 25,000,000 40,000,000

Iraq UMIC

55,000,000 60,000,000

Jordan* UMIC

14,084,507 14,084,507 16,901,408 19,718,310 19,718,310

Kuwait HIC

Lebanon* UMIC

2,786,070 2,520,730 3,316,750 4,311,774 5,041,459

Libya UMIC

Morocco LMIC

Oman HIC

9,904,775 9,904,775

Pakistan LMIC⁺ Phase 1 42,082,597

63,736,394 31,169,569 34,649,001

Qatar HIC

8,552,406 6,593,407

Saudi Arabia HIC

Somalia LIC⁺ Low

Income

Sudan* LMIC⁺ Phase 1 4,050,985 3,527,879 8,146,670 7,057,472 6,124,720

Syria LMIC

Tunisia* UMIC

2,737,437 5,993,466 5,762,213 5,826,441 5,890,669

United Arab Emirates HIC

Yemen* LMIC⁺ Phase 1 3,964,197 4,163,224 5,792,835 5,969,744 6,351,589




EMR – Percentage of total routine immunization expenditures funded by government

(JRF 6560)


Gavi grouping 2010 2011 2012 2013 2014

Afghanistan LIC⁺ Low Income 10 10 12 4

Bahrain HIC

100 100

Djibouti* LMIC⁺ Phase 1 50 38 60 98 64

Egypt LMIC

100 100 100 100 100

Iran* UMIC

100 100 100 100 100

Iraq UMIC

100 100 100 100 90

Jordan* UMIC

100 100 100 100 100

Kuwait HIC

Lebanon* UMIC

100 100 100 100 100

89


Gavi grouping 2010 2011 2012 2013 2014

Libya UMIC

Morocco LMIC

100

Oman HIC

100 100

Pakistan LMIC⁺ Phase 1 100

59 14 29

Qatar HIC

100

100 100

Saudi Arabia HIC

100

Somalia LIC⁺ Low Income 6

NA

Sudan* LMIC⁺ Phase 1 11 8 26 12 12

Syria LMIC

Tunisia* UMIC

99 99 95 99 99


Yemen* LMIC⁺ Phase 1 24 17 17 17 22




EMR – Government expenditure on vaccines (JRF 6510)


Gavi grouping

2010 2011 2012 2013 2014

Afghanistan LIC⁺ Low Income 382,000 585,000 703,379 789,645 2,050,000

Bahrain HIC

7,381,644 6,444,660 6,427,199 8,098,115 9,769,031

Djibouti* LMIC⁺ Phase 1 97,429 0 0 51,000 50,000

Egypt LMIC

56,871,701 55,594,865 49,498,416 65,509,812 63,559,322

Iran* UMIC

13,000,000 13,000,000 21,000,000 21,000,000 30,000,000

Iraq UMIC

48,000,000 51,000,000

Jordan* UMIC

14,084,507 14,084,507 16,901,408 19,718,310 19,718,310

Kuwait HIC

Lebanon* UMIC

2,514,726 2,520,730 3,316,750 3,316,750 4,975,124

Libya UMIC

Morocco LMIC

13,101,633 14,878,000 13,949,271 13,020,542

Oman HIC

9,904,775 9,904,775

Pakistan LMIC⁺ Phase 1 38,726,247 24,926,719 11,127,190 19,693,146

Qatar HIC

17,857,143

4,727,373 6,593,407 7,206,759

Saudi Arabia HIC

213,333,333

Somalia LIC⁺ Low Income 0 0 0 0 0

Sudan* LMIC⁺ Phase 1 890,199 876,715 1,736,110 2,593,240 2,721,000

Syria LMIC

24,659,269 24,829,635 25,000,000 23,057,222 21,001,559

Tunisia* UMIC

2,235,886 5,327,461 5,121,967 5,539,143 5,423,539


Yemen* LMIC⁺ Phase 1 2,675,682 3,139,247 4,802,013 4,811,886 4,988,037




90

EMR – Total expenditure on vaccines (JRF 6520)


Gavi grouping

2010 2011 2012 2013 2014

Afghanistan LIC⁺ Low Income 23,204,631 16,714,286 13,000,000 13,200,000 44,721,812

Bahrain HIC

7,381,644 6,444,660 6,427,199 8,098,115 9,769,031

Djibouti* LMIC⁺ Phase 1 374,727 297,962 631,772 490,886 350,000

Egypt LMIC

56,871,701 55,594,865 49,498,416 65,509,812 63,559,322

Iran* UMIC

13,000,000 13,000,000 21,000,000 21,000,000 30,000,000

Iraq UMIC

48,000,000 55,000,000

Jordan* UMIC

14,084,507 14,084,507 16,901,408 19,718,310 19,718,310

Kuwait HIC

Lebanon* UMIC

2,514,726 2,520,730 3,316,750 3,316,750 4,975,124

Libya UMIC

Morocco LMIC

14,292,690 14,878,000 13,949,271

Oman HIC

9,904,775 9,904,775

Pakistan LMIC⁺ Phase 1 38,726,247

49,090,208 179,028,600 83,682,525

Qatar HIC

17,857,143

4,727,373 6,593,407

Saudi Arabia HIC

213,333,333

Somalia LIC⁺ Low Income

787,606 609,726 626,291 642,857

Sudan* LMIC⁺ Phase 1 16,166,060 36,662,904 27,453,192 48,706,699 39,637,403

Syria LMIC

24,659,269 24,829,635 25,000,000 23,057,222 21,001,559

Tunisia* UMIC

2,235,886 5,327,461 5,121,967 5,539,143 5,423,539


Yemen* LMIC⁺ Phase 1 13,378,412 22,289,210 31,200,009 30,303,492 24,038,366




EMR – Percentage of total expenditure on vaccines funded by government


Gavi grouping

2010 2011 2012 2013 2014

Afghanistan LIC⁺ Low Income 2 3 5 6 5

Bahrain HIC

100 100 100 100 100

Djibouti* LMIC⁺ Phase 1 26 0 0 10 14

Egypt LMIC

100 100 100 100 100

Iran* UMIC

100 100 100 100 100

Iraq UMIC

100 100 100 100 93

Jordan* UMIC

100 100 100 100 100

Kuwait HIC

100

Lebanon* UMIC

100 100 100 100 100

Libya UMIC

Morocco LMIC

92 100 100 100 100

Oman HIC

100 100

91


Gavi grouping

2010 2011 2012 2013 2014

Pakistan LMIC⁺ Phase 1 100

23 11

Qatar HIC

100

100 100

Saudi Arabia HIC

100

Somalia LIC⁺ Low Income

0 0

0

Sudan* LMIC⁺ Phase 1 6 2 6 5 7

Syria LMIC

100 100 100 100 100

Tunisia* UMIC

100 100 100 100 100


Yemen* LMIC⁺ Phase 1 20 14 15 16 21




92

Annex 4 – European Region Tables

EUR – Government expenditure on routine immunization (JRF 6540)


Gavi grouping

2010 2011 2012 2013 2014

Albania UMIC

Andorra* HIC

609,670 635,301 571,257 580,948 493,435

Armenia LMIC⁺ Phase 2 630,000 829,500 1,029,000

3,480,744

Austria HIC

Azerbaijan* UMIC⁺ Phase 2 6,416,694 6,072,115 5,727,536 5,692,229 2,141,934

Belarus UMIC

7,241,560 7,776,989 11,586,027 8,389,860 9,987,944

Belgium HIC

Bosnia and Herzegovina

UMIC

Bulgaria* UMIC

18,465,123 31,081,510 24,358,889 14,590,119 21,258,412

Croatia HIC

Cyprus HIC

Czech Republic HIC

Denmark HIC⁺

Estonia HIC

Finland HIC

22,555,393 26,986,778 24,929,288 23,575,508 25,163,858

France HIC

Georgia* LMIC⁺ Phase 2 2,104,293 2,892,800 1,066,354 2,319,163 3,465,081

Germany HIC

Greece HIC

Hungary UMIC

13,489,392

Iceland* HIC

1,227,608 1,743,314 1,968,328 1,696,786 1,425,245

Ireland HIC

106,143,028

111,343,076

Israel HIC

Italy HIC

Kazakhstan UMIC

68,912,772

Kyrgyzstan LMIC⁺ Phase 1 754,163 754,163 757,374 815,475 857,344

Latvia HIC

6,022,448

Lithuania HIC

Luxembourg HIC

The former Yugoslav Republic of Macedonia

UMIC

4,093,689 5,935,946

Malta HIC

Monaco HIC

Montenegro UMIC

The Netherlands* HIC

116,757,331

115,518,441

114,168,167

117,943,950

106,312,292

Norway HIC

Poland HIC

93


Gavi grouping

2010 2011 2012 2013 2014

Portugal HIC

35,481,944

Republic of Moldova LMIC⁺ Phase 2 703,875

1,438,956 2,174,037 1,945,995

Romania UMIC

Russia HIC

San Marino HIC

Serbia UMIC

Slovakia HIC

Slovenia HIC

Spain HIC

Sweden HIC

Switzerland HIC

Tajikistan* LIC⁺ Phase 1 1,213,747 1,489,018 892,140 1,008,070 1,124,000

Turkey UMIC

263,889,207

237,014,925

226,614,699

200,000,000

Turkmenistan UMIC

3,557,190

Ukraine LMIC⁺ Phase 3 42,742,304 34,316,607

United Kingdom HIC

Uzbekistan LMIC⁺ Phase 2 3,213,483 6,289,992 6,289,992 9,366,500 8,652,765




EUR – Percentage of total expenditure on routine immunization funded by government

(JRF 6560)


Gavi grouping

2010 2011 2012 2013 2014

Albania UMIC

Andorra* HIC

100 100 100 100 100

Armenia LMIC⁺ Phase 2 66 65 65

99

Austria HIC

Azerbaijan* UMIC⁺ Phase 2 88 87 90 86 40

Belarus UMIC

97 97

Belgium HIC


UMIC

100

Bulgaria* UMIC

100 100 100 100 100

Croatia HIC

100 100 100 100 100

Cyprus HIC

Czech Republic HIC

100 100 100 100 100

Denmark HIC⁺

Estonia HIC

100 100 100 100 100

Finland HIC

100 100 100 100 100

France HIC

100 100 100 100 100

94


Gavi grouping

2010 2011 2012 2013 2014

Georgia* LMIC⁺ Phase 2 64 64 38 49 77

Germany HIC

Greece HIC

Hungary UMIC

100 100 100 100 100

Iceland* HIC

100 100 100 100 100

Ireland HIC

90 90

Israel HIC

100 100 100 100 100

Italy HIC

100 100 100 100 100

Kazakhstan UMIC

100 100 100 100 100

Kyrgyzstan LMIC⁺ Phase 1

6 30 9 13

Latvia HIC

100 100 100 91

Lithuania HIC

100 100 100 100 100

Luxembourg HIC

100 100 100 100 100


UMIC

100 100 100 100 100

Malta HIC

100 100 100 100 100

Monaco HIC

100 100 100 100 100

Montenegro UMIC

100 100 100 100 100


100 100 100 100 100

Norway HIC

100 100 100 100 100

Poland HIC

100 100 100 100 100

Portugal HIC

100 100 100 100 100

Republic of Moldova LMIC⁺ Phase 2 58

24 67

Romania UMIC

100 100 100 100 100

Russia HIC

100 100 100 100 100

San Marino HIC

Serbia UMIC

100 100 100 100 100

Slovakia HIC

100 100 100 100

Slovenia HIC

Spain HIC

100 100 100 100 100

Sweden HIC

100 100 100 100 100

Switzerland HIC

0 0 0 5

Tajikistan* LIC⁺ Phase 1 41 34 22 27 31

Turkey UMIC

100 100 100 100 100

Turkmenistan UMIC

100 100 100 100 100

Ukraine LMIC⁺ Phase 3 100 100 100 100 100

United Kingdom HIC

100 100 100 100 100

Uzbekistan LMIC⁺ Phase 2 51

72 80




95

EUR – Government expenditure on vaccines (JRF 6510)


Gavi grouping

2010 2011 2012 2013 2014

Albania UMIC 2,521,078

Andorra* HIC 493,676 525,600 485,528 553,941 419,681

Armenia LMIC⁺ Phase 2 630,000 829,500 1,029,000 1,576,845

Austria HIC


Belarus UMIC 7,241,560 7,776,989 11,586,027 8,389,860 5,730,540

Belgium HIC

Bosnia and Herzegovina UMIC

1,885,425 2,111,968 2,299,304 2,338,511 2,377,717

Bulgaria* UMIC 18,465,123 31,081,510 24,358,889 14,590,119 21,258,412

Croatia HIC 6,495,393 6,660,941 8,872,343

Cyprus HIC 1,990,182

Czech Republic HIC 42,744,321 46,338,417

Denmark HIC⁺

Estonia HIC 3,333,483 3,000,241 3,011,889 3,367,811 1,675,177

Finland HIC 22,555,393 26,986,778 24,929,288 23,575,508 24,511,742

France HIC

Georgia* LMIC⁺ Phase 2 2,059,783 780,300 905,544 2,274,878 1,599,639

Germany HIC

Greece HIC

Hungary UMIC 27,357,059 22,211,936 22,351,863 13,384,561

Iceland* HIC 1,227,608 1,743,314 1,968,328 1,570,414 1,425,245

Ireland HIC 49,091,150 49,408,490

Israel HIC

Italy HIC

Kazakhstan UMIC 22,645,991 40,604,999 57,656,505 74,708,011 68,912,772

Kyrgyzstan LMIC⁺ Phase 1 557,574 557,574 757,374 734,960 801,430

Latvia HIC 6,235,903 8,190,370 6,003,779 6,022,448 9,846,914

Lithuania HIC 23,882,181 17,397,356 16,713,808 17,266,569

Luxembourg HIC 8,308,345 6,994,072 6,688,737 6,909,948

The former Yugoslav Republic of Macedonia UMIC

4,267,410 4,679,997 4,021,858 5,819,555 5,779,599

Malta HIC 1,601,337

Monaco HIC

Montenegro UMIC

The Netherlands* HIC 83,587,634 76,548,365 68,140,910 70,394,475 58,471,761

Norway HIC 41,202,470 39,561,224 31,034,008 30,411,845 20,659,780

Poland HIC 27,833,353 29,976,900 32,120,448

Portugal HIC 44,712,750 41,377,871 27,648,496 35,481,944 23,816,041

Republic of Moldova LMIC⁺ Phase 2 616,364 940,577 967,891 940,746 1,806,957

Romania UMIC 22,656,471 22,961,359 21,625,050 14,123,021

96


Gavi grouping

2010 2011 2012 2013 2014

Russia HIC

San Marino HIC

Serbia UMIC

Slovakia HIC 26,372,762 20,659,783 19,139,040 19,360,818 21,590,658

Slovenia HIC 6,864,800 6,760,013 5,185,466 5,062,687 4,939,908

Spain HIC

Sweden HIC

Switzerland HIC

Tajikistan* LIC⁺ Phase 1 500,000 500,000 520,142 595,500 700,000

Turkey UMIC

169,886,829

237,014,925

226,614,699

239,754,599

200,000,000

Turkmenistan UMIC 4,077,535 3,825,026 3,572,517 3,812,365 3,557,190


United Kingdom HIC

Uzbekistan LMIC⁺ Phase 2 2,709,407 3,323,710 2,724,739 3,575,000 3,437,549




EUR – Total expenditure on vaccines (JRF 6520)


Gavi grouping

2010 2011 2012 2013 2014

Albania UMIC

2,521,078 1,060,651

Andorra* HIC

493,676 525,600 485,528 553,941 419,681

Armenia LMIC⁺ Phase 2 843,482 974,786 1,583,000

2,641,235

Austria HIC


Belarus UMIC

24,404,665 13,000,000 26,847,861

Belgium HIC


UMIC

Bulgaria* UMIC

18,465,123 31,081,510 24,358,889 14,590,119 21,258,412

Croatia HIC

6,495,393 6,660,941 8,872,343

Cyprus HIC

9,685,551

Czech Republic HIC

Denmark HIC⁺

Estonia HIC

3,333,483 3,000,241 3,011,889 3,367,811 1,675,177

Finland HIC

22,555,393 26,986,778 24,929,288 23,575,508

France HIC

Georgia* LMIC⁺ Phase 2 2,594,257 1,003,320 1,574,943 3,691,853 2,509,139

Germany HIC

1,382,512,936

1,401,530,967

1,243,192,987

1,258,471,761

Greece HIC

97


Gavi grouping

2010 2011 2012 2013 2014

Hungary UMIC

27,357,059 22,211,936 22,351,863 13,384,561

Iceland* HIC

1,227,608 1,743,314 1,968,328 1,570,414 1,425,245

Ireland HIC

49,091,150 49,408,490

Israel HIC

Italy HIC

Kazakhstan UMIC

68,912,772


1,060,651 2,051,000 8,555,267 5,721,837

Latvia HIC

6,235,903 8,190,370 6,003,779 6,628,476

Lithuania HIC

23,882,181

Luxembourg HIC

8,308,345

6,688,737 6,909,948


UMIC

4,267,410 4,679,997 4,021,858 5,819,555 5,779,599

Malta HIC

1,601,337

Monaco HIC

Montenegro UMIC


83,587,634 76,548,365 68,140,910 70,394,475 58,471,761

Norway HIC

41,202,470 39,561,224 31,034,008 30,411,845 20,659,780

Poland HIC

32,120,448

Portugal HIC

44,712,750 41,377,871 27,648,496 35,481,944 23,816,041

Republic of Moldova LMIC⁺ Phase 2 1,062,365 1,435,813 1,809,260 1,512,134 2,748,777

Romania UMIC

22,656,471 22,961,359 21,625,050 14,123,021

Russia HIC

San Marino HIC

Serbia UMIC

Slovakia HIC

26,372,762 20,659,783 19,139,040 19,360,818 22,505,417

Slovenia HIC

9,657,162 7,407,808 7,232,410 7,057,011

Spain HIC

Sweden HIC

Switzerland HIC

Tajikistan* LIC⁺ Phase 1 2,857,143 2,777,778 3,173,938 2,422,500 2,678,243

Turkey UMIC

169,886,829

237,014,925

226,614,699

239,754,599

200,000,000

Turkmenistan UMIC

4,077,535 3,825,026 3,572,517 3,812,365 3,557,190


United Kingdom HIC

Uzbekistan LMIC⁺ Phase 2

6,671,642 7,280,500 5,191,659




98

EUR – Percentage of total expenditure on vaccines funded by government


Gavi grouping

2010 2011 2012 2013 2014

Albania UMIC

100 100 100 100 100

Andorra* HIC

100 100 100 100 100

Armenia LMIC⁺ Phase 2 75 85 65

60

Austria HIC

Azerbaijan* UMIC⁺ Phase 2 78 78 88 87 43

Belarus UMIC

47 65 21

Belgium HIC


UMIC

Bulgaria* UMIC

100 100 100 100 100

Croatia HIC

100 100 100 100 100

Cyprus HIC

21

Czech Republic HIC

100 100 100 100 100

Denmark HIC⁺

Estonia HIC

100 100 100 100 100

Finland HIC

100 100 100 100 100

France HIC

100 100 100 100 100

Georgia* LMIC⁺ Phase 2 79 78 57 62 64

Germany HIC

Greece HIC

Hungary UMIC

100 100 100 100 100

Iceland* HIC

100 100 100 100 100

Ireland HIC

100 100 100 100 100

Israel HIC

100

100 100 100

Italy HIC

100 100 100 100 100

Kazakhstan UMIC

100 100 100 100 100


53 37 9 14

Latvia HIC

100 100 100 91

Lithuania HIC

100 100 100 100 100

Luxembourg HIC

100

100 100 100


UMIC

100 100 100 100 100

Malta HIC

100 100 100 100 100

Monaco HIC

100 100 100 100 100

Montenegro UMIC

100 100 100 100 100


100 100 100 100 100

Norway HIC

100 100 100 100 100

Poland HIC

100 100 100 100 100

Portugal HIC

100 100 100 100 100

Republic of Moldova LMIC⁺ Phase 2 58 66 53 62 66

Romania UMIC

100 100 100 100 100

99


Gavi grouping

2010 2011 2012 2013 2014

Russia HIC

100 100 100 100 100

San Marino HIC

Serbia UMIC

100 100 100 100 100

Slovakia HIC

100 100 100 100 96

Slovenia HIC

70 70 70 70

Spain HIC

100 100 100 100 100

Sweden HIC

100 100 100 100 100

Switzerland HIC

0 0 0 0

Tajikistan* LIC⁺ Phase 1 18 18 16 25 26

Turkey UMIC

100 100 100 100 100

Turkmenistan UMIC

100 100 100 100 100

Ukraine LMIC⁺ Phase 3 100 100 100 100 100

United Kingdom HIC

100 100 100 100 100

Uzbekistan LMIC⁺ Phase 2

41 49 66




100

Annex 5 – South Eastern Asia Region Tables

SEAR – Government expenditure on routine immunization (JRF 6540)


Gavi grouping

2010 2011 2012 2013 2014

Bangladesh* LIC⁺ Phase 1 25,122,778 23,745,000 19,624,614 16,559,890 23,907,485

Bhutan LMIC⁺ Phase 3 274,593 172,161 657,349

91,500

Democratic People’s Republic of Korea*

LIC Low Income 1,407,778 4,836,338 8,850,566 8,524,198 8,524,198

India LMIC⁺ Phase 1 98,412,712 107,134,05

7 149,708,44

3 93,604,197

100,554,650

Indonesia* LMIC⁺ Phase 2 55,094,090 66,310,633 65,798,655 65,286,678 47,458,494

Maldives UMIC

234,668 237,457

Myanmar LIC⁺ Phase 1

6,006,709

Nepal* LIC⁺ Low Income 4,975,622 2,887,911 1,985,165 4,596,751 2,066,046

Sri Lanka* LMIC⁺ Phase 3 12,384,000 3,299,314 8,606,656 13,913,997 6,139,013

Thailand* UMIC

25,247,983 27,066,002 40,835,814 38,001,490 34,067,328

Timor-Leste* LMIC⁺ Phase 2 927,794 318,357 199,876 332,636 405,000




SEAR – Percentage of government expenditure on routine immunization funded by



Gavi grouping

2010 2011 2012 2013 2014

Bangladesh* LIC⁺ Phase 1 37 37 42 33 53

Bhutan LMIC⁺ Phase 3 63 63 67

31


LIC Low Income 23 41 50 48 48

India LMIC⁺ Phase 1 100 100 100 77 80

Indonesia* LMIC⁺ Phase 2 91 99 87 77 64

Maldives UMIC

100 100 100 100 100


23

Nepal* LIC⁺ Low Income 39 22 8 46 22

Sri Lanka* LMIC⁺ Phase 3 77 53 85 100 93

Thailand* UMIC

95 100 100 100 100

Timor-Leste* LMIC⁺ Phase 2 70 17 24 71 39




101

SEAR – Government expenditure on vaccines (JRF 6510)


Gavi grouping

2010 2011 2012 2013 2014


Bhutan LMIC⁺ Phase 3 5,500 7,261 42,500 52,875 91,500


LIC Low Income 372,650 311,325 311,325 250,000 250,000

India LMIC⁺ Phase 1 39,365,085 42,853,623 52,397,955 45,530,720 89,102,811


Maldives UMIC

234,668 225,025


1,353,007 1,276,970 1,200,933



Thailand* UMIC

22,723,184 24,359,396 36,752,224 34,201,333 31,650,441





SEAR – Total expenditure on vaccines (JRF 6520)


Gavi grouping

2010 2011 2012 2013 2014


Bhutan LMIC⁺ Phase 3 105,500 163,521 300,000 235,000 297,500


LIC Low Income 1,800,000 4,038,394 6,276,787 3,500,000 3,500,000

India LMIC⁺ Phase 1

42,853,623 52,397,955 72,750,172 114,303,73

8


Maldives UMIC

234,668 225,025


2,431,378 2,863,307 2,647,342



Thailand* UMIC

23,919,141 24,359,396 36,752,224 34,201,333 31,650,441





102

SEAR – Percentage of total expenditure on vaccines funded by government (JRF 6530)


Gavi grouping

2010 2011 2012 2013 2014

Bangladesh* LIC⁺ Phase 1 29 30 37 30 56

Bhutan LMIC⁺ Phase 3 5 4 14 23 31


LIC Low Income 21 8 5 7 7

India LMIC⁺ Phase 1 100 100 100 63 78

Indonesia* LMIC⁺ Phase 2 100 100 100 85 78

Maldives UMIC

100 100 100 100 100


56 45 45

Nepal* LIC⁺ Low Income 39 20 45 36 29

Sri Lanka* LMIC⁺ Phase 3 57 39 40 41 94

Thailand* UMIC

95 100 100 100 100

Timor-Leste* LMIC⁺ Phase 2 90 100 26 76 81




103

Annex 6 – Western Pacific Region Tables

WPR – Government expenditure on routine immunization (JRF 6540)


Gavi grouping

2010 2011 2012 2013 2014

Australia HIC

336,715,676 361,073,566 294,483,505

Brunei Darussalam HIC

Cambodia* LIC⁺ Low

Income 2,778,140 3,055,958 2,665,531 2,275,105 9,163,487

China* UMIC

299,809,462 313,848,694 321,266,944 311,344,782 314,000,391

Cook Islands N/A

Fiji UMIC

Japan HIC

Kiribati LMIC⁺ Phase 2

41,258

Lao People's Democratic Republic

(the)* LMIC⁺ Phase 1 320,000 285,000 250,000 250,000 4,473,785

Malaysia UMIC

39,737,978 41,830,065 43,922,153 46,014,241

Marshall Islands* UMIC

23,500 30,000 30,000 30,000 30,000

Micronesia LMIC

10,000

Mongolia LMIC⁺ Phase 3

1,509,543 1,331,699 2,521,155 2,359,866

Nauru N/A

New Zealand HIC

56,305,184 67,458,098 78,201,453

Niue N/A

Palau UMIC

Papa New Guinea* LMIC⁺ Phase 2 1,103,225 1,687,052 3,157,827 2,118,620 3,293,813

Philippines LMIC

53,203,635

46,469,689 56,312,394

Republic of Korea HIC

34,000,000 65,000,000

205,000,000 389,000,000

Samoa LMIC

152,923 151,831 150,000 148,913

Singapore HIC

Solomon Islands* LMIC⁺ Phase 1 1,022,647 1,022,647 1,200,602 765,520 330,438

Tonga UMIC

47,219 57,837 58,156 50,741

Tuvalu UMIC

5,081 5,081

Vanuatu LMIC

123,832 115,890 107,948 115,784 123,620

Vietnam* LMIC⁺ Phase 2 8,717,900 10,571,840 11,424,520 11,163,000 13,215,076




104

WPR – Percentage of total expenditure on routine immunization funded by government

(JRF 6560)


Gavi grouping

2010 2011 2012 2013 2014

Australia HIC

100 100 100 100 100



Income 23 39 35 25 55

China* UMIC

100 100 100 100 100

Cook Islands N/A

80

Fiji UMIC

90 100 100 100 100

Japan HIC


53

100

Lao People's Democratic Republic

(the)* LMIC⁺ Phase 1 7 7 6 6 48

Malaysia UMIC

80 80


1 2 2 2 2

Micronesia LMIC

0

Mongolia LMIC⁺ Phase 3 24 69 74 95 74

Nauru N/A

New Zealand HIC

100 100 100 100 100

Niue N/A

100 100 100

Palau UMIC

Papa New Guinea* LMIC⁺ Phase 2 75 30 36 33 54

Philippines LMIC

100

99 100


52

100

Samoa LMIC

100 100 100 100 100

Singapore HIC

Solomon Islands* LMIC⁺ Phase 1 9 70 69 58 36

Tonga UMIC

80 100 100 100 100

Tuvalu UMIC

20 20 20

Vanuatu LMIC

62

80

25

Vietnam* LMIC⁺ Phase 2 39 33 36 40 44




105

WPR – Government expenditure on vaccines (JRF 6510)


Gavi grouping

2010 2011 2012 2013 2014

Australia HIC

275,545,771 340,587,932 328,950,093 324,773,122 262,213,809


324,317 1,538,688 1,093,548 2,527,841 1,696,570


Income 1,130,366 1,068,217 1,174,231 1,997,291 2,246,340

China* UMIC

269,828,516 282,463,824 289,140,250 279,723,361 282,109,255

Cook Islands N/A

14,000

20,000

Fiji UMIC

625,554 647,991 670,429 1,058,977 5,700,000

Japan HIC


41,258

Lao People's Democratic

Republic (the)* LMIC⁺ Phase 1 100,000 113,827 200,000 200,000 570,385

Malaysia UMIC

39,737,978 41,830,065 40,792,541 40,623,314 39,109,047


23,500 30,000 30,000 30,000 30,000

Micronesia LMIC

6,000

Mongolia LMIC⁺ Phase 3 1,311,764 1,446,153 1,318,776 2,242,456 2,183,838

Nauru N/A

3,900 12,578 2,492 5,546

New Zealand HIC

33,508,727 32,696,005 33,872,538 37,501,811 43,486,781

Niue N/A

5,054 7,918 8,108 5,744

Palau UMIC

Papa New Guinea* LMIC⁺ Phase 2 790,446 951,178 2,320,910 1,673,087 1,141,938

Philippines LMIC

31,035,454 49,098,313 44,992,991 36,022,827 40,544,924


30,000,000 53,000,000

125,000,000 189,000,000

Samoa LMIC

152,174 151,087 150,000 148,913

Singapore HIC

1,173,451 1,262,398 1,360,326 1,440,305

Solomon Islands* LMIC⁺ Phase 1 348,104 148,264 166,979 147,508 180,438

Tonga UMIC

47,219 52,688 58,156 50,741

Tuvalu UMIC

5,081 5,081 5,081

Vanuatu LMIC

82,182 89,416 107,948 97,756 87,564





106

WPR – Total expenditure on vaccines (JRF 6520)


Gavi grouping

2010 2011 2012 2013 2014

Australia HIC

275,545,771 340,587,932 328,950,093 324,773,122 262,213,809


324,317 1,538,688 1,093,548 1,395,059 1,696,570


Income 2,808,589 4,695,909 4,789,135 5,228,651 4,976,806

China* UMIC

269,828,516 282,463,824 289,140,250 279,723,361 282,109,255

Cook Islands N/A

14,000

Fiji UMIC

625,554 647,991 670,429 1,900,728 7,000,000

Japan HIC


61,633


Republic (the)* LMIC⁺ Phase 1 2,000,000 1,954,584 2,000,000 2,460,095 4,770,776

Malaysia UMIC

49,672,472 52,287,582


1,700,000 1,300,000 1,300,000 1,300,000 1,300,000

Micronesia LMIC

2,000,000

Mongolia LMIC⁺ Phase 3 1,639,582 2,097,127 1,769,002 2,660,533 2,480,885

Nauru N/A

3,900 12,578 3,195 5,546

New Zealand HIC

33,508,727 32,696,005 33,872,538 37,501,811 43,486,781

Niue N/A

5,054 7,918 8,108 5,744

Palau UMIC

250,000

Papa New Guinea* LMIC⁺ Phase 2 1,342,337 2,128,049 2,878,380 2,693,920 3,180,000

Philippines LMIC

31,035,454 49,098,313 54,465,199 36,030,825 40,544,924


62,000,000

189,000,000

Samoa LMIC

152,174 151,087 150,000 148,913

Singapore HIC

1,173,451 1,262,398 1,360,326 1,440,305

Solomon Islands* LMIC⁺ Phase 1 773,635 317,020 361,379 271,508 281,172

Tonga UMIC

52,466 55,311 58,156

Tuvalu UMIC

25,407 25,000 25,000

Vanatu LMIC

558,852 134,935 160,182 185,430





107

WPR – Percentage of total expenditure on vaccines funded by government (JRF 6530)


Gavi grouping

2010 2011 2012 2013 2014

Australia HIC

100 100 100 100 100


100 100 100 100 100


Income 40 23 25 38 45

China* UMIC

100 100 100 100 100

Cook Islands N/A

90 100

Fiji UMIC

100 100 100 56 81

Japan HIC


67

100 10


Republic (the)* LMIC⁺ Phase 1 5 6 10 8 12

Malaysia UMIC

80 80


1 2 2 2 2

Micronesia LMIC

0

Mongolia LMIC⁺ Phase 3 80 69 75 84 88

Nauru N/A

100 100 100 100 100

New Zealand HIC

100 100 100 100 100

Niue N/A

100 100 100 100 100

Palau UMIC

Papa New Guinea* LMIC⁺ Phase 2 59 45 81 62 36

Philippines LMIC

100 100 83 100 100


48

100

Samoa LMIC

100 100 100 100 100

Singapore HIC

100 100 100 100 100

Solomon Islands* LMIC⁺ Phase 1 45 47 46 54 64

Tonga UMIC

90 100 100 100 100

Tuvalu UMIC

20 20 20

Vanuatu LMIC

16 80 61 47

Vietnam* LMIC⁺ Phase 2 28 30 34 43 43




108

Annex 7 – International exchange rate comparison – government

expenditure on routine immunization per live birth The following table presents the indicator Government expenditure on routine immunization (JRF

6540) per live birth expressed in 3 different currency conversions:

1. Nominal US dollars ($).

2. 2010 Constant US dollars ($).

3. Purchasing Power Parity (PPP) Current International dollars ($).

The population weighted average was calculated for each region and over the entire group of

countries which exhibited a full time-series and had available conversion data. In order to convert

the data into 2010 constant US$, GDP deflator data was taken from the World Bank’s World

Development Indicators. The calculation for purchasing power parity international $, made use of

the Price level ratio of PPP conversion factor (GDP) to market exchange rate also taken from the

World Bank’s World Development Indicators.

Region No. of

Countries Average

Type 2010 2011 2012 2013 2014

Percentage change 2010 -

2014

AFRO 18 Nominal US$ PWA 5.7 5.3 5.3 5.3 5.8 3%

AMRO 23 Nominal US$ PWA 157.6 144.2 138.6 143.2 181.5 15%

EMRO 7 Nominal US$ PWA 12.1 12.6 17.2 17.9 21.7 80%

EURO 6 Nominal US$ PWA 209.4 220.1 198.3 185.8 172.7 -18%

SEARO 6 Nominal US$ PWA 13.2 13.0 14.1 14.0 11.3 -14%

WPRO 7 Nominal US$ PWA 17.3 18.1 18.3 17.4 18.0 4%

Global 67 Nominal US$ PWA 35.8 34.2 33.8 33.9 39.0 9%

AFRO 18 2010 Constant

US$ PWA 5.7 4.9 4.7 4.6 4.9 -13%

AMRO 23 2010 Constant

US$ PWA 157.6 133.0 121.7 118.5 140.8 -11%

EMRO 7 2010 Constant

US$ PWA 12.1 10.8 13.1 12.0 13.4 11%

EURO 6 2010 Constant

US$ PWA 209.4 214.9 191.6 178.5 164.2 -22%

SEARO 6 2010 Constant

US$ PWA 13.2 12.2 12.8 12.1 9.4 -29%

WPRO 7 2010 Constant

US$ PWA 17.3 16.7 16.5 15.3 15.7 -9%

Global 67 2010 Constant

US$ PWA 35.8 31.8 30.0 28.7 31.3 -13%

AFRO 18 PPP

International $ PWA 13.2 12.0 11.6 11.4 13.4 2%

AMRO 23 PPP


EMRO 7 PPP


EURO 6 PPP

International $ PWA 245.5 259.4 239.1 206.1 200.9 -18%

SEARO 6 PPP


WPRO 7 PPP


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Analysis of Immunization Financing Indicators of the WHO ... · Analysis of Immunization Financing Indicators of the WHO-UNICEF Joint Reporting Form (JRF), 2010-2014 Department of